Sedation with fentanyl and midazolam without oropharyngeal anesthesia compared with sedation with pethidine and midazolam with oropharyngeal anesthesia in ultrathin bronchoscopy for peripheral lung lesions

Sumi, Toshiyuki; Kamada, Koki; Sawai, Takeyuki; Shijubou, Naoki; Yamada, Yuichi; Nakata, Hajime; Mori, Yoshihiro; Chiba, Hirofumi

doi:10.1016/j.resinv.2020.10.001

Cited by 9 publications

(13 citation statements)

References 22 publications

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“…Of these, 15 articles were excluded according to the protocol, and two studies missed in the database search were added [ 22 , 23 ]. Therefore, 19 studies formed the basis of our systematic review [ 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 1,977 PPLs were included. Table 2 lists the study characteristics and summarizes their features [ 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. Six studies were randomized controlled trials, six were prospective, and seven were retrospective studies.…”

Section: Resultsmentioning

confidence: 99%

“…The inverse variance weighted overall diagnostic yield was 0.65 (95% CI, 0.60–0.70) (Fig. 3 ) [ 13 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. The diagnostic yield among studies ranged from 0.38 to 0.90. χ 2 value of 87.75 ( p < 0.01) and I 2 index of 79.5% (95% CI, 68.7–86.6) indicated substantial heterogeneity across studies.…”

Section: Resultsmentioning

confidence: 99%

“…The recent development of 1.7 mm channel size allows the passage of r-EBUS [28], which provides a 360° view of the surrounding lesion by the ultrasound transducer [43] and shows a pooled diagnostic yield of 0.73 (95% CI, 0.70-0.76) [40]. The r-EBUS probe position relative to the lesion was known to be associated with the diagnostic yield of TBB, where the diagnostic yield of within, adjacent to, and outside the lesion was Shinagawa 2004 [24] Yamamoto 2004 [25] Shinagawa 2007 [26] Tachihara 2007 [27] Oki 2009 [28] Matsuno 2011 [22] Oki 2012 [29] Asano 2013 [30] Oki 2015 [31] Franzen 2016 [32] Tokoro 2016 [33] Ali 2019 [34] Diez-Ferrer 2019 [35] Oki 2019 [13] Sehgal 2019 [36] Sumi 2020 [37] Kawakita 2021 [38] Sumi 2021 [39] Zheng 2021 [23] Total (95% CI) 0.83, 0.61, and 0.04, respectively (p < 0.001) [44]. In line with this, Nishi et al [45] reported that UTB showed improved r-EBUS probe position for PPL after substituting thin bronchoscope (adjacent, 12; not visible, 32) by UTB (within, 26; adjacent, 11; not visible, 7) combined with fluoroscopy and VBN.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, our study was not registered prior to the review, but we followed the suggested PRIS-MA protocol. Asano 2013 [30] Oki 2015 [31] Diez-Ferrer 2019 [35] Oki 2019 [13] Sumi 2020 [37] Sumi 2021 [39] Zheng 2021 [23] Total (95% Cl) Heterogeneity: τ 2 = 0.0272; χ 2 = 20.09, df = 7 (p < 0.01); I 2 = 65% Test for overall effect: Z = -2. 29 Oki 2009 [28] Oki 2015 [31] Oki 2019 [13] Sumi 2020 [37] Sumi 2021 [39] Zheng 2021 [23] Total (95% Cl)…”

Section: Discussionmentioning

confidence: 99%

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Ultrathin Bronchoscopy for the Diagnosis of Peripheral Pulmonary Lesions: A Meta-Analysis

Kim

Pak

et al. 2022

Respiration

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Background: Ultrathin bronchoscopy (external diameter, ≤3.5 mm) is useful for the diagnosis of peripheral pulmonary lesions because of its good accessibility. Objectives: We performed a meta-analysis to investigate the diagnostic yield of ultrathin bronchoscopy for peripheral pulmonary lesions. Methods: We performed a systematic search of MEDLINE and EMBASE (from inception to May 2021), and meta-analysis was performed using R software. The diagnostic yield was evaluated by dividing the number of successful diagnoses by the total number of lesions, and subgroup analysis was performed to identify related factors. Results: Nineteen studies with a total of 1,977 peripheral pulmonary lesions were included. The pooled diagnostic yield of ultrathin bronchoscopy was 0.65 (95% confidence interval, 0.60–0.70). Significant heterogeneity was observed among studies (χ2, 87.75; p < 0.01; I2, 79.5%). In a subgroup analysis, ultrathin bronchoscopy with 1.2 mm channel size showed a diagnostic yield of 0.61 (95% confidence interval, 0.53–0.68), whereas ultrathin bronchoscopy with 1.7 mm channel size showed 0.70 (95% confidence interval, 0.66–0.74) (χ2, 5.35; p = 0.02). In addition, there was a significant difference in diagnostic yield based on lesion size, histologic diagnosis (malignant vs. benign), bronchus sign, and lesion location from the hilum, whereas no significant difference was found based on lobar location. The overall complication rate of ultrathin bronchoscopy was 2.7% (pneumothorax, 1.1%). Conclusions: Ultrathin bronchoscopy is an excellent tool for peripheral pulmonary lesion diagnosis with a low complication rate. The diagnostic yield of ultrathin bronchoscopy was significantly higher with larger channel size, which might be attributed to the availability of radial endobronchial ultrasound.

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