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Salguero BD, Agrawal A, Kaul V, Lo Cascio CM, Joy G, So M, Munagala R, Harkin T, Chaddha U. Airway stenting for liberation from positive pressure ventilation in patients with central airway obstruction presenting with acute respiratory failure. Respir Med 2024; 225:107599. [PMID: 38492817 DOI: 10.1016/j.rmed.2024.107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/05/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Central airway obstruction (CAO) can lead to acute respiratory failure (RF) necessitating positive pressure ventilation (PPV). The efficacy of airway stenting to aid liberation from PPV in patients with severe acute RF has been scarcely published. We present a systematic review and our recent experience. METHODS A systematic review of PubMed was performed, and a retrospective review of cases performed at our two institutions from 2018 to 2022 in adult patients who needed stent insertion for extrinsic or mixed CAO complicated by RF necessitating PPV. RESULTS Fifteen studies were identified with a total of 156 patients. The weighted mean of successful liberation from PPV post-stenting was 84.5% and the median survival was 127.9 days. Our retrospective series included a total of 24 patients. The most common etiology was malignant CAO (83%). The types of PPV used included high-flow nasal cannula (HFNC) (21%), non-invasive ventilation (NIV) (17%) and Invasive Mechanical Ventilation (62%). The overall rate of successful liberation from PPV was 79%, with 55% of HFNC and NIV cases being liberated immediately post-procedure. The median survival of the patients with MCAO that were successfully liberated from PPV was 74 days (n = 16, range 3-893 days), and for those with that failed to be liberated from PPV, it was 22 days (n = 4, range 9-26 days). CONCLUSION In patients presenting with acute RF from extrinsic or mixed morphology CAO requiring PPV, airway stenting can successfully liberate most from the PPV. This may allow patients to receive pathology-directed treatment and better end-of-life care.
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Affiliation(s)
- Bertin D Salguero
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Abhinav Agrawal
- Division of Pulmonary, Critical Care and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Viren Kaul
- Division of Pulmonary and Critical Care Medicine, Crouse Health/SUNY Upstate Medical University, Syracuse, USA
| | - Christian M Lo Cascio
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Greta Joy
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matsuo So
- Department of Medicine, Mount Sinai Beth Israel, New York, NY, USA
| | - Rohit Munagala
- Department of Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Timothy Harkin
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Udit Chaddha
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Hasselbring F, Herth FJF, Kriegsmann M, Kriegsmann K, Eberhardt R. Transbronchial Cryobiopsy Using the Ultrathin 1.1-mm Cryoprobe with Ultrathin Bronchoscopy under Radial Endobronchial Ultrasound Guidance for Diagnosis of Peripheral Pulmonary Lesions. Respiration 2024; 103:268-274. [PMID: 38471486 DOI: 10.1159/000538196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Today, the increasing number of incidentally detected peripheral pulmonary lesions (PPLs) within and outside lung cancer screening trials is a diagnostic challenge. This fact encourages further improvement of diagnostic procedures to increase the diagnostic yield of transbronchial biopsy, which has been shown to have a low complication rate. The purpose of this study was to evaluate the safety and feasibility of a new ultrathin 1.1 cryoprobe that can be placed through an ultrathin bronchoscope (UTB) using fluoroscopy and radial endobronchial ultrasonography (rEBUS) navigation for assessing PPLs. METHODS Thirty-five patients with PPL less than 4 cm in diameter were prospectively enrolled to receive transbronchial cryobiopsies (TBCBs) using the ultrathin 1.1-mm cryoprobe. Navigation to the PPL was accomplished with the UTB. Under rEBUS and fluoroscopy guidance up to 4 cryobiopsies were obtained. The sample sizes of the biopsies were compared to a historic collective derived from a 1.9-mm cryoprobe and standard forceps. The feasibility and safety of the procedure, the cumulative and overall diagnostic yield, and the cryobiopsy sizes were evaluated. RESULTS After detection with the rEBUS, TBCB was collected from 35 PPLs, establishing a diagnosis in 25 cases, corresponding to an overall diagnostic yield of 71.4%. There was no difference in diagnostic yield for PPL <20 mm or ≥20 mm. All cryobiopsies were representative with a mean tissue area of 11.9 ± 4.3 mm2, which was significantly larger compared to the historic collective (p = 0.003). Six mild and four moderate bleeding events and 1 case of pneumothorax were observed. CONCLUSIONS Using the ultrathin 1.1-mm cryoprobe combined with an UTB for rEBUS-guided TBCB of PPL is feasible and safe. This diagnostic approach improves bronchoscopic techniques for diagnosing peripheral lung lesions and may contribute to improve diagnosis of lung cancer even in small PPL.
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Affiliation(s)
- Franziska Hasselbring
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Felix J F Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Mark Kriegsmann
- Department of General Pathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
- Centre of Histology, Cytology and Molecular Pathology, Wiesbaden, Germany
| | - Katharina Kriegsmann
- Department of Hematology, Oncology, and Rheumatology, Heidelberg University Hospital, Heidelberg, Germany
- Laborarztpraxis Rhein-Main MVZ GbR, Frankfurt am Main, Germany
| | - Ralf Eberhardt
- Pneumology and Critical Care Medicine, Asklepios Klinik Barmbek, Hamburg, Germany
- Asklepios Tumor Center Hamburg (ATZHH), Hamburg, Germany
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3
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Goussard P, Eber E, Venkatakrishna S, Janson J, Schubert P, Andronikou S. Bronchoscopy findings in children with congenital lung and lower airway abnormalities. Paediatr Respir Rev 2024; 49:43-61. [PMID: 37940462 DOI: 10.1016/j.prrv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Congenital lung and lower airway abnormalities are rare, but they are an important differential diagnosis in children with respiratory diseases, especially if the disease is recurrent or does not resolve. The factors determining the time of presentation of congenital airway pathologies include the severity of narrowing, association with other lesions and the presence or absence of congenital heart disease (CHD). Bronchoscopy is required in these cases to assess the airway early after birth or when intubation and ventilation are difficult or not possible. Many of these conditions have associated abnormalities that must be diagnosed early, as this determines surgical interventions. It may be necessary to combine imaging and bronchoscopy findings in these children to determine the correct diagnosis as well as in operative management. Endoscopic interventional procedures may be needed in many of these conditions, ranging from intubation to balloon dilatations and aortopexy. This review will describe the bronchoscopic findings in children with congenital lung and lower airway abnormalities, illustrate how bronchoscopy can be used for diagnosis and highlight the role of interventional bronchoscopy in the management of these conditions.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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4
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Saad F, Frysch R, Saalfeld S, Kellnberger S, Schulz J, Fahrig R, Bhadra K, Nürnberger A, Rose G. Deformable 3D/3D CT-to-digital-tomosynthesis image registration in image-guided bronchoscopy interventions. Comput Biol Med 2024; 171:108199. [PMID: 38394801 DOI: 10.1016/j.compbiomed.2024.108199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/30/2024] [Accepted: 02/18/2024] [Indexed: 02/25/2024]
Abstract
Traditional navigational bronchoscopy procedures rely on preprocedural computed tomography (CT) and intraoperative chest radiography and cone-beam CT (CBCT) to biopsy peripheral lung lesions. This navigational approach is challenging due to the projective nature of radiography, and the high radiation dose, long imaging time, and large footprints of CBCT. Digital tomosynthesis (DTS) is considered an attractive alternative combining the advantages of radiography and CBCT. Only the depth resolution cannot match a full CBCT image due to the limited angle acquisition. To address this issue, preoperative CT is a good auxiliary in guiding bronchoscopy interventions. Nevertheless, CT-to-body divergence caused by anatomic changes and respiratory motion, hinders the effective use of CT imaging. To mitigate CT-to-body divergence, we propose a novel deformable 3D/3D CT-to-DTS registration algorithm employing a multistage, multiresolution approach and using affine and elastic B-spline transformation models with bone and lung mask images. A multiresolution strategy with a Gaussian image pyramid and a multigrid strategy within the B-spline model are applied. The normalized correlation coefficient is included in the cost function for the affine model and a multimetric weighted cost function is used for the B-spline model, with weights determined heuristically. Tested on simulated and real patient bronchoscopy data, the algorithm yields promising results. Assessed qualitatively by visual inspection and quantitatively by computing the Dice coefficient (DC) and the average symmetric surface distance (ASSD), the algorithm achieves mean DC of 0.82±0.05 and 0.74±0.05, and mean ASSD of 0.65±0.29mm and 0.93±0.43mm for simulated and real data, respectively. This algorithm lays the groundwork for CT-aided intraoperative DTS imaging in image-guided bronchoscopy interventions with future studies focusing on automated metric weight setting.
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Affiliation(s)
- Fatima Saad
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany.
| | - Robert Frysch
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
| | - Sylvia Saalfeld
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Jessica Schulz
- Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany; Siemens Healthcare GmbH, Forchheim, Germany
| | | | - Krish Bhadra
- CHI Memorial Rees Skillern Cancer Institute, Chattanooga, USA
| | - Andreas Nürnberger
- Data and Knowledge Engineering Group, Faculty of Computer Science, Otto-von-Guericke University, Magdeburg, Germany
| | - Georg Rose
- Institute for Medical Engineering, Otto-von-Guericke University, Magdeburg, Germany; Forschungscampus STIMULATE, Otto-von-Guericke University, Magdeburg, Germany
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Samadzadeh Tabrizi N, Stout PA, Fabian T, Fabian T. The role of interventional bronchoscopy in the management of malignant central airway obstruction. Respir Med Case Rep 2024; 47:101984. [PMID: 38298452 PMCID: PMC10828452 DOI: 10.1016/j.rmcr.2024.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024] Open
Abstract
Nearly a third of patients with primary lung cancer present with malignant central airway obstruction (MCAO), and some of them appear to have advanced disease. In these patients, accurate staging is crucial. Although the literature extensively outlines the role of interventional bronchoscopy in palliation, its contribution to refining the staging of patients with MCAO is noteworthy. Here, we present a case of a patient initially diagnosed with stage IV cancer due to a left mainstem tumor causing complete lung collapse. He was referred to our institution for palliative treatment of his cough. Following interventional bronchoscopy, the patient's staging was revised to T1a, and subsequently, he underwent lobectomy without complications.
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Affiliation(s)
| | | | - Tyler Fabian
- Department of Thoracic Surgery, Albany Medical Center, Albany, NY, 12208, USA
| | - Thomas Fabian
- Department of Thoracic Surgery, Albany Medical Center, Albany, NY, 12208, USA
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Yazaki T, Sonehara K, Araki T, Komatsu M, Tateishi K, Yasuo M, Hanaoka M. Impact of Interventional Bronchoscopy on Long-Term Survival in Patients with Primary Tracheal Adenoid Cystic Carcinoma: A Single-Center Experience. Case Rep Oncol 2024; 17:305-310. [PMID: 38390454 PMCID: PMC10883689 DOI: 10.1159/000535738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/03/2023] [Indexed: 02/24/2024] Open
Abstract
Introduction Primary tracheal adenoid cystic carcinoma (TACC) is a rare low-grade lung cancer of bronchial gland origin. Surgery is the first choice of treatment; however, in cases of recurrence or inoperability, a combination of radiation and chemotherapy is administered as a multimodality treatment. Interventional bronchoscopy is also used as a multidisciplinary treatment; however, its impact on long-term prognosis has not been thoroughly investigated. Case Presentation Eight patients diagnosed with TACC and treated at Shinshu University Hospital between December 2000 and August 2023 were analyzed retrospectively. We investigated the duration of intervention and overall survival (OS) in 3 patients with recurrence who underwent interventional bronchoscopy in combination with chemotherapy and evaluated whether interventional bronchoscopy prolonged the survival. The initial treatment for the 3 patients was surgery in 1 patient and chemoradiotherapy in 2. In all patients, raised lesions were observed in the trachea at the time of recurrence. The duration of interventional bronchoscopy, the time from recurrence of the first-line treatment to death, and OS, which was defined time from induction of the first-line treatment to death, were 69.3/70.7/112.5 months, 179.2/196.1/220.4 months, and 15.4/66.3/104.4 months, respectively. Conclusion Long-term survival benefits may be obtained with concomitant interventional bronchoscopy in combination with chemotherapy in patients with locally recurrent TACC.
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Affiliation(s)
- Tatsuya Yazaki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kei Sonehara
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Taisuke Araki
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Masanori Yasuo
- Department of Clinical Laboratory Sciences, Shinshu University School of Health Sciences, Matsumoto, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
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7
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Wayne MT, Ali MS, Wakeam E, Maldonado F, Yarmus LB, Prescott HC, De Cardenas J. Current Practices in Airway Stent Management: A National Survey of US Practitioners. Respiration 2023; 102:608-612. [PMID: 37429267 DOI: 10.1159/000531500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 05/29/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Despite a growing number of tracheobronchial stent types and indications, complications remain frequent, and high-quality evidence on practices to prevent stent-related complications is lacking. Understanding current management practice is a first step to designing prospective studies to assess whether specific practices aimed at mitigating stent-related complications improve patient-centered outcomes. OBJECTIVES In this study, we aimed to understand current management strategies following tracheobronchial stenting. METHOD We performed a nationwide survey of members of the American Association of Bronchology and Interventional Pulmonology (AABIP) and the General Thoracic Surgical Club (GTSC) who place airway stents. The electronic survey captured data on practitioners' demographics, practice setting, airway stent volume, and standard post-stent practices (if any) including the use of medications, mucus clearance devices, surveillance imaging, and surveillance bronchoscopy. RESULTS One hundred thirty-eight physicians completed the survey. Respondents were majority male (75.4%) and had diverse training (50.0% completed interventional pulmonary fellowship; 18.1% thoracic surgery; 31.9% other stent training). Post-stent management strategies varied markedly across respondents; 75.4% prescribe at least one medication to prevent post-stent complications, 52.9% perform routine surveillance bronchoscopy in asymptomatic patients, 26.1% prescribe mucus clearance regimens, 16.7% obtain routine computed tomography scans in asymptomatic patients, and 8.3% routinely replace their stents prior to stent failure. CONCLUSIONS In this national survey of practitioners who place airway stents, there was marked heterogeneity in post-stent management approaches. Further studies are needed to identify which, if any, of these strategies improve patient-centered outcomes.
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Affiliation(s)
- Max T Wayne
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Division of Pulmonary and Critical Care Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Muhammad Sajawal Ali
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Elliot Wakeam
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Center for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Jose De Cardenas
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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8
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Li C, Li Y, Jin F, Bo L. The bleeding risk and safety of multiple treatments by bronchoscopy in patients with central airway stenosis. Expert Rev Respir Med 2023; 17:329-335. [PMID: 37026852 DOI: 10.1080/17476348.2023.2201440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
BACKGROUND Central airway obstruction (CAO) are common abnormality that usually needing interventional bronchoscopy, and sometimes multiple rounds of treatment. However, there were few studies explore the safety of it. RESEARCH DESIGN & METHODS The records of patients who underwent interventional bronchoscopy because of CAO at Respiratory department between January 1, 2010, and December 31, 2020 were revised. The patients' clinical characteristics, information about bronchoscopy and incidence of complications were collected and analyzed. RESULTS There were totally 1,482 bronchoscopy procedures conducted in the 733 CAO patients. And the incidence of major complications in the retreatment group was significantly lower than that in the first treatment group ((4.77% vs. 1.87%, χ2=9.78, df=1, p<0.01), so did the incidence of severe bleeding (2.46% vs. 0.40%, χ2=11.20, df=1, p<0.01). However, there was some variability between the two groups in age and anesthesia type. A short interval time, more treatment times, and general anesthesia were related to a lower incidence of hemorrhage. For patients who were previously bleeding, the incidence of hemorrhage was significantly higher than the incidence in the non-bleeding patients (42.93% vs. 16.33%, respectively; χ2=57.54, df=1, p<0.01). CONCLUSION For the patients with CAO, repeated interventional bronchoscopy treatment was safe, and it should be treated with discretion when retreat the patients once bleeding during previous therapeutic bronchoscopy.
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Affiliation(s)
- Congcong Li
- Department of Respiratory and Critical Care Medicine, General Hospital of Northern Theater Command, Shenyang, 110016, PR China
| | - Yanyan Li
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Air Force Medical University, Xinsi Road 1, Xi'an, 710038, PR China
| | - Faguang Jin
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Air Force Medical University, Xinsi Road 1, Xi'an, 710038, PR China
| | - Liyan Bo
- Department of Respiratory and Critical Care Medicine, General Hospital of Northern Theater Command, Shenyang, 110016, PR China
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9
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Goussard P, Eber E, Venkatakrishna S, Frigati L, Janson J, Schubert P, Andronikou S. Intrathoracic tuberculosis: Role of interventional bronchoscopy in diagnosis. Paediatr Respir Rev 2023; 45:23-29. [PMID: 36621398 DOI: 10.1016/j.prrv.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Tuberculosis (TB) is the leading cause of death from a single infectious agent globally. Mortality is related to the delay in diagnosis and starting treatment. According to new guidelines it is very important to classify pulmonary tuberculosis (PTB) as severe or not severe disease due to the difference in treatment duration. Bronchoscopy is the gold standard for assessing the degree of airway compression and obstruction in paediatric PTB. Paediatric bronchoscopy has evolved from a primarily diagnostic procedure to include interventional bronchoscopy for diagnostic purposes. Endobronchial ultrasound (EBUS) has increased the potential of sampling mediastinal lymph nodes both for histological diagnosis and microbiological confirmation.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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10
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Goussard P, Eber E, Venkatakrishna S, Frigati L, Janson J, Schubert P, Andronikou S. Complicated intrathoracic tuberculosis: Role of therapeutic interventional bronchoscopy. Paediatr Respir Rev 2023; 45:30-44. [PMID: 36635200 DOI: 10.1016/j.prrv.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
In recent years bronchoscopy equipment has been improved with smaller instruments and larger size working channels. This has ensured that bronchoscopy offers both therapeutic and interventional options. As the experience of paediatric interventional pulmonologists continues to grow, more interventions are being performed. There is a scarcity of published evidence in the field of interventional bronchoscopy in paediatrics. This is even more relevant for complicated pulmonary tuberculosis (PTB). Therapeutic interventional bronchoscopy procedures can be used in the management of complicated tuberculosis, including for endoscopic enucleations, closure of fistulas, dilatations of bronchial stenosis and severe haemoptysis. Endoscopic therapeutic procedures in children with complicated TB may prevent thoracotomy. If done carefully these interventional procedures have a low complication rate.
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Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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11
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Héluain V, Dutau H, Plat G, Brindel A, Guibert N. [Bronchoscopic management of malignant central airway obstructions]. Rev Mal Respir 2023; 40:94-100. [PMID: 36577607 DOI: 10.1016/j.rmr.2022.11.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022]
Abstract
Up to 30% of lung cancer patients suffer from central airway obstruction, resulting in major deterioration in prognosis and quality of life. Interventional bronchoscopy combines a number of invasive techniques used during rigid bronchoscopy. It is designed to rapidly improve symptoms, primarily dyspnea. Applied according to very precise indications, this technique requires careful patient selection and needs to be incorporated into the multimodal oncological management in combination with systemic treatments, radiation therapy and surgery.
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Affiliation(s)
- V Héluain
- Unité d'endoscopie thoracique, service de pneumologie, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - H Dutau
- Service d'oncologie thoracique, maladies de la plèvre et pneumologie interventionnelle, hôpital Nord, Marseille, France
| | - G Plat
- Unité d'endoscopie thoracique, service de pneumologie, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - A Brindel
- Unité d'endoscopie thoracique, service de pneumologie, hôpital Larrey, CHU de Toulouse, Toulouse, France
| | - N Guibert
- Unité d'endoscopie thoracique, service de pneumologie, hôpital Larrey, CHU de Toulouse, Toulouse, France.
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12
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Hamad SG, Abushahin A, Abdulsattar H, Waqas K, Abu-Hasan M. Successful management of congenital bronchial web in an adolescent using bronchoscopic ablation: A case report and review of literature. Respir Med Case Rep 2022; 41:101786. [PMID: 36561962 PMCID: PMC9763669 DOI: 10.1016/j.rmcr.2022.101786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/05/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Airway webs are abnormal fibrous membranes in the airway lumen that rarely occur but can lead to serious or even life-threatening symptoms because of critical airway obstruction. Airway webs can be acquired or congenital. Acquired webs are likely to be secondary to trauma, infections, or neoplasm. Congenital laryngeal, subglottic and tracheal webs present early in infancy or childhood and are more common than congenital bronchial webs. To our knowledge, there are a few reports on the bronchial web in the literature, and the true incidence of these lesions is unknown as many probably go undetected across the lifespan. We here report a case of a congenital bronchial web and provide a review of the literature of all reported bronchial webs. Our patient is a teenage boy who was diagnosed with a congenital bronchial web obstructing the right main-stem bronchus (RMB) and causing right lung hypoplasia and persistent right middle and right lower lobe collapse. The web was treated successfully using endoscopic ablation by argon plasma coagulation and balloon dilatation. Treatment resulted in remarkable relief of right main stem obstruction and significant improvement in right lung collapse as well as clinical, spirometric, and radiological findings. Due to the rarity of bronchial web, the clinical knowledge and the bronchoscopic interventional strategies demonstrated of this report make it relevant. Furthermore, it emphasizes that early diagnosis and management lead to favorable clinical outcomes.
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Affiliation(s)
- Sara G. Hamad
- Pediatric Pulmonology, Sidra Medicine, Doha, Qatar,Corresponding author.
| | | | | | - Kashif Waqas
- Biomedical Engineering, Sidra Medicine, Doha, Qatar
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13
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Harris K, Schaefer E, Rosenblum J, Stewart FD, Arkovitz MS. Intraoperative electromagnetic navigation bronchoscopy (IENB) to localize peripheral lung lesions: A new technique in the pediatric oncology population. J Pediatr Surg 2022; 57:179-182. [PMID: 34893311 DOI: 10.1016/j.jpedsurg.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/03/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The utility, diagnostic yield and accuracy of lung biopsies in pediatric oncology patients are variable. Here we describe our preliminary results using intraoperative electromagnetic navigation bronchoscopy (IENB) for peripheral lung lesions to increase the surgical yield and accuracy in pediatric oncology patients. METHODS From May 2018 until October 2020 all surgical lung biopsies on pediatric oncology patients were performed using IENB technology. IENB and tattooing with methylene blue dye, Indocyanine green dye or both followed by Video-assisted Thoracoscopic Surgery (VATS) was performed in the same setting. Data were collected retrospectively. Data points included diagnosis, technical success, pathologic diagnosis and alteration in treatment management and complications. RESULTS A total of 10 biopsy procedures were performed on 8 patients during the study. The youngest patient was 7 years old. All had successful IENB with tattooing. All biopsies were diagnostic. No procedures were converted to open. There were no technical failures or procedure complications. One patient had a total of 11 biopsies, 6 from the right lung and 5 from the left, performed at 2 separate procedures. Another had 2 biopsies, one from the right lung and one from the left performed at the same operation. In 7 of the 8 patients treatment changes were made based on results of their biopsy. CONCLUSION Here we present the first described experience of IENB and tattooing of peripheral lung lesions in the pediatric population. We have shown that IENB for peripheral lung lesion localization is a safe and effective technique in pediatric oncology.
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Affiliation(s)
- Kassem Harris
- Division of Pulmonary Medicine, Department of Internal Medicine, Westchester Medical Center, Valhalla, NY, USA
| | - Edo Schaefer
- Division of Pediatric Oncology, Department of Pediatrics, Westchester Medical Center, Valhalla, NY, USA
| | - Jeremy Rosenblum
- Division of Pediatric Oncology, Department of Pediatrics, Westchester Medical Center, Valhalla, NY, USA
| | - F Dylan Stewart
- Division of Pediatric Surgery, Department of Surgery, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, NY, USA
| | - Marc S Arkovitz
- Division of Pediatric Surgery, Department of Surgery, Westchester Medical Center, Maria Fareri Children's Hospital, Valhalla, NY, USA.
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14
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Baden W, Hofbeck M, Warmann SW, Schaefer JF, Sieverding L. Interventional closure of a bronchopleural fistula in a 2 year old child with detachable coils. BMC Pediatr 2022; 22:250. [PMID: 35513808 PMCID: PMC9074316 DOI: 10.1186/s12887-022-03298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Bronchopleural fistula (BPF) is a severe complication following pneumonia or pulmonary surgery, resulting in persistent air leakage (PAL) and pneumothorax. Surgical options include resection, coverage of the fistula by video-assisted thoracoscopic surgery (VATS), or pleurodesis. Interventional bronchoscopy is preferred in complex cases and involves the use of sclerosants, sealants and occlusive valve devices. Case presentation A 2.5-year-old girl was admitted to our hospital with persistent fever, cough and dyspnoea. Clinical and radiological examination revealed right-sided pneumonia and pleural effusion. The child was started on antibiotics, and the effusion was drained by pleural drainage. Following removal of the chest tube, the child developed tension pneumothorax. Despite insertion of a new drain, the air leak persisted. Thoracoscopic debridement with placement of another new drain was performed after 4 weeks, without abolishment of the air leak. Bronchoscopy with bronchography revealed a BPF in right lung segment 3 (right upper-lobe anterior bronchus). We opted for an interventional approach that was performed under general anaesthesia during repeat bronchoscopy. Following bronchographic visualisation of the fistula, a 2.7 French microcatheter was placed in right lung segment 3 (upper lobe), allowing occlusion of the fistula by successive implantation of 4 detachable high-density packing volume coils, which were placed into the fistula. Subsequent bronchography revealed no evidence of residual leakage, and the chest tube was removed 2 days later. The chest X-ray findings normalized, and follow-up over 4 years was uneventful. Conclusions Bronchoscopic superselective occlusion of BPF using detachable high-density packing large-volume coils was a successful minimally invasive therapeutic intervention performed with minimal trauma in this child and has not been reported thus far. In our small patient, the short interventional time, localized intervention and minimal damage in the lung seemed superior to the corresponding outcomes of surgical lobectomy or pleurodesis in a young growing lung, enabling normal development of the surrounding tissue. Follow-up over 4 years did not show any side effects and was uneventful, with normal lung-function test results to date. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03298-y.
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Affiliation(s)
- Winfried Baden
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany.
| | - Michael Hofbeck
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany
| | - Steven W Warmann
- Department Paediatric Surgery and Paediatric Urology, Children's Hospital, University of Tuebingen, Tuebingen, Germany
| | - Juergen F Schaefer
- Department Radiology, Division of Paediatric Radiology, University Hospital, Tuebingen, Germany
| | - Ludger Sieverding
- Department Paediatrics 2, Pulmonology, Cardiology, Intensive Care, Children's Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 1, 72076, Tuebingen, Germany
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15
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Senitko M, Oberg CL, Abraham GE, Hillegass WB, Akhtar I, Folch E. Microwave Ablation for Malignant Central Airway Obstruction: A Pilot Study. Respiration 2022; 101:666-674. [PMID: 35316812 PMCID: PMC9393822 DOI: 10.1159/000522544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background Malignant central airway obstruction (CAO) is a debilitating complication of primary lung cancer and pulmonary metastases. Therapeutic bronchoscopy is used to palliate symptoms and/or bridge to further therapy. Microwave ablation (MWA) heats tissue by creating an electromagnetic field around an ablation device. We present a pilot study utilizing endobronchial MWA via flexible bronchoscopy as a novel modality for the management of malignant CAO. Methods Therapeutic bronchoscopy with a flexible MWA probe was performed in 8 cases. We reviewed tumor size, previous ablative techniques, number of applications, ablation time, amount of energy delivered, rate of successful recanalization, complications, and 30-day follow-up. Results Successful airway recanalization was achieved in all cases. No complications were noted. In 1 case, tumor in-growth within a silicone stent was ablated with no damage to the stent. Discussion Endobronchial MWA is a novel technique for tumor destruction while maintaining an airway axis. The oven effect and air gap around a tumor allow for safe and effective tissue devitalization and hemostasis without a thermal effect on structures surrounding the airway.
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Affiliation(s)
- Michal Senitko
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Division of Cardiothoracic Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Catherine L Oberg
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - George E Abraham
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - William B Hillegass
- Departments of Data Science and Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Israh Akhtar
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA.,Department of Pathology and Laboratory Medicine, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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16
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Posthuma R, Vaes AW, Walraven KHM, Sardari Nia P, Schreiber JU, Gietema HA, Wesseling G, Wouters EFM, Vanfleteren LEGW. Implementation of Bronchoscopic Lung Volume Reduction Using One-Way Endobronchial Valves: A Retrospective Single-Centre Cohort Study. Respiration 2021; 101:476-484. [PMID: 34937034 DOI: 10.1159/000520885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction (BLVR) using 1-way endobronchial valves (EBV) has become a guideline treatment in patients with advanced emphysema. Evidence from this minimally invasive treatment derives mainly from well-designed controlled trials conducted in high-volume specialized intervention centres. Little is known about real-life outcome data in hospitals setting up this novel treatment and which favourable conditions are required for a continuous successful program. OBJECTIVES In this study, we aim to evaluate the eligibility rate for BLVR and whether the implementation of BLVR in our academic hospital is feasible and yields clinically significant outcomes. METHOD A retrospective evaluation of patients treated with EBV between January 2016 and August 2019 was conducted. COPD assessment test (CAT), forced expiratory volume in 1 s (FEV1), residual volume (RV), and 6-min walking test (6MWT) were measured at baseline and 3 months after intervention. Paired sample t tests were performed to compare means before and after intervention. RESULTS Of 350 subjects screened, 283 (81%) were not suitable for intervention mostly due to lack of a target lobe. The remaining 67 subjects (19%) underwent bronchoscopic assessment, and if suitable, valves were placed in the same session. In total, 55 subjects (16%) were treated with EBV of which 10 did not have complete follow-up: 6 subjects had their valves removed because of severe pneumothorax (n = 2) or lack of benefit (n = 4) and the remaining 4 had missing follow-up data. Finally, 45 patients had complete follow-up at 3 months and showed an average change ± SD in CAT -4 ± 6 points, FEV1 +190 ± 140 mL, RV -770 ± 790 mL, and +37 ± 65 m on the 6MWT (all p < 0.001). After 1-year follow-up, 34 (76%) subjects had their EBV in situ. CONCLUSION Implementing BLVR with EBV is feasible and effective. Only 16% of screened patients were eligible, indicating that this intervention is only applicable in a small subset of highly selected subjects with advanced emphysema, and therefore a high volume of COPD patients is essential for a sustainable BLVR program.
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Affiliation(s)
- Rein Posthuma
- Department of Research and Development, Ciro, Horn, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Anouk W Vaes
- Department of Research and Development, Ciro, Horn, The Netherlands
| | - Kim H M Walraven
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jan U Schreiber
- Department of Anaesthesiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hester A Gietema
- Department of Radiology, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Geertjan Wesseling
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Emiel F M Wouters
- Department of Research and Development, Ciro, Horn, The Netherlands.,Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - Lowie E G W Vanfleteren
- Department of Respiratory Medicine and Allergology, COPD Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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17
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Yang F, Zhang W, Han C, Jiang H. A case of pulmonary inflammatory myofibroblastic tumor treated with bronchoscopic therapy plus lobectomy. J Cardiothorac Surg 2021; 16:144. [PMID: 34039398 PMCID: PMC8157757 DOI: 10.1186/s13019-021-01528-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background Inflammatory myofibroblastic tumor (IMT) is a rare tumor with malignant potential. We presented a case of a young adult who was diagnosed with IMT and treated with loop electrocautery therapy to relieve airway obstruction, followed by lobectomy to complete resection. Recent studies have supported the use of such interventional resection methods. Case presentation A non-smoking 30-year-old woman presented with a 1-month history of progressive dyspnea and productive cough. The Chest X-ray showed a homogenous opacity invading the entire left hemithorax, and the mediastinum content was attracted to the left side. In an effort to avoid pneumonectomy and afford rapid palliation of dyspnea, loop electrocautery was selected as the most appropriate therapy. The left upper lobectomy by thoracoscopy was performed instead of left upper lobe sleeve resection in order to better prevent the recurrence of lung atelectasis. After 6 years of follow-up, no evidence of recurrence has been found till now. Conclusion Interventional bronchoscopy coupled with surgical resection serves not only as a palliative management to bronchial obstruction but also a way to avoid pneumonectomy.
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Affiliation(s)
- Fan Yang
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Jianggan District, Hangzhou, 310016, China
| | - Wenxia Zhang
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Jianggan District, Hangzhou, 310016, China
| | - Cheng Han
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Jianggan District, Hangzhou, 310016, China
| | - Hanliang Jiang
- Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun East Road, Jianggan District, Hangzhou, 310016, China.
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18
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Sun K, Zhang H, Wang G. Bronchoscopic retrograde recanalization of complete tracheal obliteration after tracheostomy. Auris Nasus Larynx 2021; 49:1046-1050. [PMID: 34001393 DOI: 10.1016/j.anl.2021.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/14/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
Complete tracheal obliteration after tracheostomy remains a considerable challenge for otolaryngologists and pulmonologists. Here, we report for the first time a novel method of interventional bronchoscopy to successfully recanalize complete tracheal obliteration. Three patients with suprastomal tracheal obliteration and tracheostomy dependence were referred to our center for further management. Using interventional bronchoscopy, a TBNA needle was retrogradely inserted from the stoma to locate the original passage through the occlusion, and then its stylet was left as a guide wire for the sequential dilations. Once the tracheal lumen was restored, endoprosthesis would be implanted to maintain the airway patency. All cases achieved successful recanalization with effortless breathing after the treatment and restored phonation. Bronchoscopic retrograde recanalization using a TBNA needle is a promising and effective treatment for complete tracheal obliteration.
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Affiliation(s)
- Kunyan Sun
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China
| | - Hong Zhang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China
| | - Guangfa Wang
- Department of Respiratory and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing 100034, China.
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19
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Virot E, Marcot C, Vergnon JM, Matau C, Porzio M, Kessler R. Airway stent current practices evaluation: Survey among French bronchoscopy practitioners. Respir Med Res 2020; 77:89-94. [PMID: 32492650 DOI: 10.1016/j.resmer.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 01/14/2020] [Accepted: 02/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Airway stenting (AS) is performed for the treatment of benign or malignant central airway stenosis. In France, more than 30 centers practice AS. The aim of this survey was to evaluate the current practice around airway stenting among French bronchoscopy practitioners. METHOD We performed an online survey sent to the GELF group (Groupe d'Endoscopie de Langue Française) mailing list. The first part comprised 10 questions about the different attitudes before AS and the second part included 10 questions about the management after AS. RESULTS Thirty-six participants answered to the first part of the questionnaire and thirty-three to the second. There were some similarities, for example the absence of prophylactic antibiotic treatment before procedure (86%), use of saline nebulization, and removing or replacing the airway stent in case of persistent chest congestion or infection (73%). We also noted an important heterogeneity of the practices with several differences concerning systematic endoscopic control, bacteriological sampling before procedure (44%) and systematically AS replacement. CONCLUSION This survey shows that AS management in France varies between practitioners. Respondents agreed on a few points, but disagreed on several important aspects of the management. These results emphasize the need of expert recommendations to improve AS management.
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Affiliation(s)
- E Virot
- Respiratory Disease Department, Strasbourg University Hospital, Strasbourg, France.
| | - C Marcot
- Respiratory Disease Department, Strasbourg University Hospital, Strasbourg, France
| | - J-M Vergnon
- Department of Pulmonology, University Hospital of Saint-Étienne, 42000 Saint-Étienne, France
| | - C Matau
- Respiratory Disease Department, Strasbourg University Hospital, Strasbourg, France
| | - M Porzio
- Respiratory Disease Department, Strasbourg University Hospital, Strasbourg, France
| | - R Kessler
- Respiratory Disease Department, Strasbourg University Hospital, Strasbourg, France
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20
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Abstract
Surgery for non-small cell lung cancer has undergone repeated innovations over time. Although medical thoracoscopy has been available for centuries, it was not incorporated into the standard approach until the 1990s, when successful video-assisted thoracoscopic surgery (VATS) techniques were widely reported. Progressive efforts to offer minimally invasive approaches while maintaining oncologic surgical quality led to the development of robotic-assisted thoracic surgery and uniportal VATS, which offer improved pain control, shorter hospital stays, and more patients able to receive adjuvant therapy. Innovations in interventional bronchoscopy, localization methods, and 3D printing have improved the safety, efficacy, and precision of surgery.
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21
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Hetzel J, Linzenbold W, Boesmueller H, Enderle M, Poletti V. Evaluation of Efficacy of a New Cryoprobe for Transbronchial Cryobiopsy: A Randomized, Controlled in vivo Animal Study. Respiration 2020; 99:248-256. [PMID: 32101862 DOI: 10.1159/000506017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/18/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Forceps biopsy (FB) is still the most popular procedure for the bronchoscopic sampling of lung tissue. However, it has limitations like inadequate sample size and crush artifacts. Cryobiopsy (CB) has been introduced to obtain bronchoscopic biopsies with improved diagnostic yield compared to FB. Limitations of CB are the need to retract the cryoprobe en bloc with bronchoscope because samples are larger than the working channel and the variations of the freezing power of the reusable CB (rCB). Therefore, 3 new disposable cryoprobes (dCB) have been developed with different outer diameters: 1.1 mm (CB11-S) that can be retracted through the working channel of the bronchoscope, 1.7 mm (CB17) and 2.4 mm (CB24n), respectively. OBJECTIVES The aim was to evaluate the new cryoprobes with regard to feasibility, specimen area, specimen quality and complications. METHODS We compared biopsy samples of the new probes with those obtained by FB and by rCB in an in vivo (porcine) model. A flexible bronchoscope was used to perform biopsy at 4 different locations at the upper and lower lobes of the right and left lung, respectively. The biopsies were taken under fluoroscopic control. The biopsy tool and activation times were allocated randomly. Altogether 204 biopsy procedures were performed. RESULTS The sample quality of the dCB was superior to that of FB (all p < 0.05) and not significantly different to the rCB sample quality. Mean specimen sample area of all CB was significantly larger compared to FB (p < 0.05). The sample area of the small cryoprobe (CB11-S) was significantly smaller compared to the other CB probes (p < 0.05). No severe bleedings occurred. Pneumothoraces were detected in 3 of the 7 pigs. CONCLUSION We conclude that CB with the new single-use instruments are feasible and represent a viable option to improve the diagnostic accuracy of histopathological evaluation compared to FB.
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Affiliation(s)
- Jürgen Hetzel
- Department of Medical Oncology and Pneumology, University of Tübingen, Tübingen, Germany,
| | | | - Hans Boesmueller
- Institute of Pathology and Neuropathology, University of Tübingen, Tübingen, Germany
| | | | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy.,Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
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22
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Freitas C, Martins N, Novais-Bastos H, Morais A, Fernandes G, Magalhães A. The role of interventional bronchoscopy in the management of post-intubation tracheal stenosis: A 20-year experience. Pulmonology 2019; 27:296-304. [PMID: 31901372 DOI: 10.1016/j.pulmoe.2019.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Benign tracheal stenosis management is still controversial, and there is no international consensus on the best treatment option. Thus, we aimed to look into the history of PITS and the different strategies used in its treatment. The importance of bronchoscopic treatment was also defined, and its effectiveness and safety were assessed. METHODS Retrospective study of patients diagnosed with PITS, who were referred to the Bronchology Department between January 1996 and December 2016. RESULTS Of 115 patients enrolled (mean age 48.5±17.6 years, 53% males), 66.1% had complex stenosis. The most common causes of intubation were respiratory (29.9%), neurological (26.8%) and surgical (19.6%). Complex stenosis was caused by longer intubation, and was more frequent among previously tracheostomized patients. The most common location was the upper third of trachea (60.9%). Most cases were initially treated by interventional bronchoscopy, and although serial dilations were effective in some complex PITS, a higher proportion of simple stenosis was successfully managed with this treatment option. Long-term recurrence after serial dilation was observed in 25.0% of cases. Stent placement was required (19.1%) only for complex PITS. Stent-related complications were frequent (61.9%) and linked to the stenting time (p<0.001). Overall, there were no procedure-related complications. Surgical intervention was also performed (30.0%), always with complex PITS. Post-surgical recurrences were observed in 24.2% of cases. CONCLUSIONS Interventional bronchoscopy is an efficient and safe modality in PITS management. Further studies are needed for better classification and improved knowledge of PITS pathogenesis, and to achieve international consensus of definition to guide clinicians in their practice.
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Affiliation(s)
- C Freitas
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal.
| | - N Martins
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-136 Porto, Portugal
| | - H Novais-Bastos
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Institute for Research and Innovation in Health, University of Porto, Rua Alfredo Allen, 208, 4200-136 Porto, Portugal
| | - A Morais
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - G Fernandes
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal; Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
| | - A Magalhães
- Department of Pulmonology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal
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Skoczyński S, Minarowski Ł, Tobiczyk E, Oraczewska A, Glinka K, Ficek K, Mróz R, Barczyk A. Noninvasive Ventilation-Facilitated Bronchofiberoscopy in Patients with Respiratory Failure. Adv Exp Med Biol 2019; 1160:53-64. [PMID: 30989590 DOI: 10.1007/5584_2019_375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Respiratory failure is one of the most important risk factors for diagnostic bronchofiberoscopy (BF), whereas therapeutic bronchoscopies are typically performed in intubated patients. Only a few published studies analyzed the outcomes of noninvasive mechanical ventilation (NIV)-facilitated BF. In this case series, we present our experiences with NIV-facilitated diagnostic and therapeutic BF performed in patients with respiratory failure that was associated with acute interstitial pulmonary disease, chronic obstructive pulmonary disease, cystic fibrosis exacerbation, foreign body aspiration, tracheal stenosis, pneumonia, and in a patient with a neuromuscular disease. All of the patients were initially hypoxic and some had PaO2/FiO2 < 200, which corresponded to moderate-to-acute respiratory distress syndrome (ARDS). NIV-facilitated BF were performed for the diagnostic or therapeutic purposes. The former consisted of bronchoalveolar lavage and bacterial sampling in a patient with impaired cough reflex, airway assessment in otherwise unexplained respiratory failure and hemoptysis, and the latter of mucous plugs resolution, foreign body removal, and assistance in weaning from mechanical ventilation. All procedures were carried out using NIV in the spontaneous timed (ST) or average volume assured pressure support (AVAPS) mode with oxygen supplementation. There were no procedure-related complications noticed during NIV-facilitated BF. We conclude that NIV is a useful and safe tool that facilitates the performance of BF in severe pulmonary diseases. Prospective studies are required to set the recommendations for the procedure and to define the optimum ventilatory modes to be used.
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Jin F, Li Q, Li S, Wang H, Bai C, Zeng Y, Zhou R, Cai Z, Chen L, Feng J, Feng Q, Guo S, Hou G, Huang H, Lai G, Li W, Wang C, Zhang N, Zhou Y. Interventional Bronchoscopy for the Treatment of Malignant Central Airway Stenosis: An Expert Recommendation for China. Respiration 2019; 97:484-494. [PMID: 30970361 DOI: 10.1159/000497213] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/23/2019] [Indexed: 11/19/2022] Open
Abstract
Malignant central airway stenosis refers to airway stenosis caused by primary or metastatic malignant tumors which may lead to different levels of dyspnea or asphyxia in patients. With the rapid development of interventional pulmonology, therapeutic bronchoscopy has become one of the main methods for the diagnosis and treatment of malignant central airway stenosis. However, the level of diagnosis and treatment of respiratory intervention techniques in China is uneven at present, the treatment methods are not uniform, the treatment effects vary greatly, and some treatments even lead to serious complications. The interventional treatment technology for malignant central airway stenosis in China needs to be standardized. Therefore, the relevant experts of the Beijing Health Promotion Association Respiratory and Oncology Intervention and Treatment Alliance have formulated this consensus after several rounds of full discussion.
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Affiliation(s)
- Faguang Jin
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China,
| | - Qiang Li
- Department of Respiratory and Critical Care Medicine, Dongfang Hospital, Tongji University, Shanghai, China
| | - Shiyue Li
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongwu Wang
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yiming Zeng
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Hospital of Fujian Medical University, Quanzhou, China
| | - Rui Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhigang Cai
- Department of Respiratory and Critical Care Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liangan Chen
- Department of Respiratory and Critical Care Medicine, PLA General Hospital, Beijing, China
| | - Jing Feng
- Department of Respiratory and Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin, China
| | - Qixiao Feng
- Department of Respiratory and Critical Care Medicine, Southern Medical University Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou, China
| | - Shuliang Guo
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Hou
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Haidong Huang
- Department of Respiratory Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Guoxiang Lai
- Department of Respiratory Pulmonary and Critical Care Medicine, The General Hospital of Fuzhou Military Region, Fuzhou, China
| | - Wangping Li
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Changhui Wang
- Department of Respiratory Pulmonary and Critical Care Medicine, Tenth People's Hospital of Shanghai, Shanghai, China
| | - Nan Zhang
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Yunzhi Zhou
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
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Abstract
Endobronchial ablative therapies, such as mechanical debulking, laser therapy, electrocautery, argon plasma coagulation, cryotherapy, brachytherapy, photodynamic therapy, microdebrider bronchoscopy, resector balloon deobstruction, and intratumoral chemotherapy, are performed through a rigid or flexible bronchoscope in palliating or curing symptomatic malignant and benign airway lesions to improve symptoms, quality of life, and survival. Technical factors together with patient- and lesion-specific features determine the therapy of choice, as each therapy is different in capacity, limitation, and complications. In this article, indications, contraindications, and complications of endobronchial ablative therapies as well as practical issues related to their rational and cost-effective use are reviewed.
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Affiliation(s)
- Semra Bilaçeroğlu
- Health Sciences University, Izmir Dr. Suat Seren Training and Research Hospital for Thoracic Medicine and Surgery, 35110, Izmir, Turkey.
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Abstract
Background Interventional bronchoscopy is considered an effective treatment option for malignant central airway obstruction (MCAO). However, there are few reports of interventional bronchoscopy in patients with MCAOs due to extra-pulmonary malignancy. Therefore, the objective of this study was to investigate treatment outcomes and prognostic factors for bronchoscopic intervention in patients with MCAO due to extra-pulmonary malignancy. Methods We retrospectively analyzed consecutive 98 patients with MCAO due to extra-pulmonary malignancy who underwent interventional bronchoscopy between 2004 and 2014 at Samsung Medical Center (Seoul, Korea). Results The most common primary site of malignancy was esophageal cancer (37.9%), followed by thyroid cancer (16.3%) and head & neck cancer (10.2%). Bronchoscopic interventions were usually performed using a combination of mechanical debulking (84.7%), stent insertion (70.4%), and laser cauterization (37.8%). Of 98 patients, 76 (77.6%) patients had MCAO due to progression of malignancy, and 42 (42.9%) patients had exhausted all other anti-cancer treatment at the time of bronchoscopic intervention. Technical success was achieved in 89.9% of patients, and acute complications and procedure-related deaths occurred in 20.4% and 3.1% of patients, respectively. Reduced survival was associated with MCAO due to cancer other than thyroid cancer or lymphoma, mixed lesions, and not receiving adjuvant treatment after bronchoscopic intervention. Conclusions Bronchoscopic intervention could be a safe and effective procedure for MCAO due to end-stage extra-pulmonary malignancies. In addition, we identified possible prognostic factors for poor survival after intervention, which could guide clinicians select candidates that will benefit from bronchoscopic intervention.
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Affiliation(s)
- Beomsu Shin
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Boksoon Chang
- Department of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Yasuo M, Kitaguchi Y, Kinota F, Kosaka M, Urushihata K, Ushiki A, Yamamoto H, Kawakami S, Hanaoka M. Usefulness of the forced oscillation technique in assessing the therapeutic result of tracheobronchial central airway obstruction. Respir Investig 2018; 56:222-229. [PMID: 29773293 DOI: 10.1016/j.resinv.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/07/2017] [Accepted: 01/21/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary function tests (PFTs) comprise the traditional method for detecting central airway obstruction (CAO) and evaluating therapeutic effects, but are effort-dependent. By contrast, the forced oscillation technique (FOT) is performed during tidal breathing in an effort-independent mode and is universally used to assess respiratory function in patients with chronic obstructive pulmonary disease (COPD) and asthma. We used the FOT to measure airway resistance and reactance in patients with CAO before and after interventional bronchoscopy and compared the results to data obtained using PFTs. METHODS Twelve patients with CAO were recruited from December 2013 to July 2016. The FOT, PFTs, chest computed tomography (CT), COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale were employed before and after interventional bronchoscopy. The minimum airway cross-sectional area (MACSA) was calculated using a CT image calculator. RESULTS Of the 12 patients, 6 had tracheal obstruction and 6 had bronchial obstruction. All FOT measurements, except ΔX5, were significantly improved after interventional bronchoscopy in all cases. The significance of the improvement was greater with the FOT than PFTs. The MACSA, CAT, and mMRC dyspnea scale scores also significantly improved in all cases. Furthermore, only alteration of resistance at 20 Hz (R20) significantly correlated with the alteration of the MACSA after intervention. No significant correlations were found for PFTs. CONCLUSIONS The FOT is suitable and convenient for assessing therapeutic results in patients with tracheobronchial CAO. The alteration of R20 is useful for estimating the airway dilation of CAO after interventional bronchoscopy.
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Affiliation(s)
- Masanori Yasuo
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Yoshiaki Kitaguchi
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Fumiya Kinota
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Makoto Kosaka
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Kazuhisa Urushihata
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Atsuhito Ushiki
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Hiroshi Yamamoto
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Satoshi Kawakami
- Department of Radiology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
| | - Masayuki Hanaoka
- The First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan.
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Guibert N, Mhanna L, Didier A, Moreno B, Leyx P, Plat G, Mazieres J, Hermant C. Integration of 3D printing and additive manufacturing in the interventional pulmonologist's toolbox. Respir Med 2018; 134:139-42. [PMID: 29413501 DOI: 10.1016/j.rmed.2017.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/28/2017] [Indexed: 12/30/2022]
Abstract
New 3D technologies are rapidly entering into the surgical landscape, including in interventional pulmonology. The transition of 2D restricted data into a physical model of pathological airways by three-dimensional printing (3DP) allows rapid prototyping and fabrication of complex and patient-specific shapes and can thus help the physician to plan and guide complex procedures. Furthermore, computer-assisted designed (CAD) patient-specific devices have already helped surgeons overcome several therapeutic impasses and are likely to rapidly cover a wider range of situations. We report herein with a special focus on our clinical experience: i) how additive manufacturing is progressively integrated into the management of complex central airways diseases; ii) the appealing future directions of these new technologies, including the potential of the emerging technique of bioprinting; iii) the main pitfalls that could delay its introduction into routine care.
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29
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Kızılgöz D, Aktaş Z, Yılmaz A, Öztürk A, Seğmen F. Comparison of two new techniques for the management of malignant central airway obstruction: argon plasma coagulation with mechanical tumor resection versus cryorecanalization. Surg Endosc 2017; 32:1879-1884. [PMID: 29052061 DOI: 10.1007/s00464-017-5877-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 09/06/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The development of central airway obstruction during malignant diseases is an important cause of morbidity and mortality. Endobronchial therapies can decrease the patient's symptoms and improve quality of life. Here, we compare airway recanalization methods: argon plasma coagulation with mechanical tumor resection (APC + MTR) and cryorecanalization (CR efficiency, complications, restenosis rate, and time to restenosis) in patients with malignant exophytic endobronchial airway obstruction. METHODS A total of 89 patients were included who were admitted to our hospital between 2005 and 2012. The data were analyzed retrospectively. Initially, a CR procedure was performed in 52 patients using rigid bronchoscopy under general anesthesia; the APC + MTR procedure was performed in 37 patients with malignant airway obstruction. RESULTS The airway patency rate with APC + MTR was 97.3% (n = 36) and CR was 80.8% (n = 42). The APC + MTR procedure was more effective than CR for recanalization of malignant endobronchial exophytic airway obstruction. Additionally, the achievement rate of airway patency with APC + MTR was significantly higher in tumors with distal bronchial involvement. There was no statistically significant difference between groups in terms of complications, restenosis rate, and time to restenosis. CONCLUSIONS The APC + MTR procedure is preferred over CR to introduce and maintain airway patency in patients with malignancy-related endobronchial exophytic airway obstruction.
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Affiliation(s)
- Derya Kızılgöz
- Department of Chest Disease, Ankara Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital, 06290, Ankara, Turkey.
| | - Zafer Aktaş
- Department of Chest Disease and Interventional Pulmonology, Ankara Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Aydın Yılmaz
- Department of Chest Disease and Interventional Pulmonology, Ankara Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Ayperi Öztürk
- Department of Chest Disease and Interventional Pulmonology, Ankara Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Fatih Seğmen
- Department of Chest Disease, Ankara Atatürk Chest Disease and Thoracic Surgery Training and Research Hospital, 06290, Ankara, Turkey
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Abstract
Endoscopic lung volume reduction (ELVR) presents an effective therapy in patients with advanced emphysema. Different ELVR techniques are available differing in mechanism of action, degree of reversibility and safety. Precise patient selection with respect to pulmonary function test, emphysema distribution, and collateral ventilation are prerequisites for a successful use of the various ELVR techniques. To date, there are only a few randomized controlled trials for bronchoscopic therapy in patients with chronic obstructive pulmonary disease, so the various techniques should be performed within clinical trials or registry studies.
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Affiliation(s)
- Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Röntgenstr. 1, Heidelberg 69126, Germany
| | - Felix J F Herth
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Röntgenstr. 1, Heidelberg 69126, Germany.
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31
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Abstract
Interventional bronchoscopy has a predominant role in the management of both early and advanced-stage airway tumors. Given the very poor prognosis of lung cancer, there is a need for new tools to improve early detection and bronchoscopic treatment of endo-bronchial precancerous lesions. In more advanced stages, interventional bronchoscopy plays an important role, as nearly a third of lung cancers lead to proximal airway obstruction. This will cause great discomfort or even life-threatening symptoms related to local extension, such as dyspnea, post-obstructive pneumonia, and hemoptysis. Surgery for very locally advanced disease is only effective for a limited number of patients and the effects of conventional antitumor therapies, like radiation therapy or chemotherapy, are inconstant and are too delayed in a palliative context. In this review, we aim to provide pulmonologists with an exhaustive technical overview of (I) the bronchoscopic management of benign endobronchial lesions; (II) the bronchoscopic management of malignant tumors, including the curative treatment of localized lesions and palliative management of malignant proximal airway stenosis; and (III) descriptions of the emerging endoscopic techniques used to treat peripheral lung tumors.
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Affiliation(s)
- Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Laurent Mhanna
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Sylvain Droneau
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Gavin Plat
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Alain Didier
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Julien Mazieres
- Pulmonology Department, Larrey University Hospital, Toulouse, France
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Abstract
INTRODUCTION More than 150,000 solitary pulmonary nodules are reported each year in the United States. As the popularity of low dose CT scan use for screening grows, these numbers are likely to increase substantially over the coming years. More than 10 million CT scans of the chest were performed in the United States alone in 2012, highlighting the potential for this clinical scenario. Detecting a nodule on either a chest radiograph or a CT scan frequently leads to a cascade of further investigations to establish a definite diagnosis. Thoracic surgery is frequently performed to obtain a tissue diagnosis in these cases, however, for what often turns out to be a benign abnormality. AREAS COVERED During the last decade, several new technologies have been introduced to the field of bronchoscopy. As experience with these technologies has increased, the body of published literature has grown. Expert commentary: In this review, we assess the most important and interesting articles in the field. The value and the limitations of the various options will be discussed based on the actual evidence.
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Affiliation(s)
- Felix Jf Herth
- a Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL) , University of Heidelberg , Heidelberg , Germany
| | - Ralf Eberhardt
- a Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL) , University of Heidelberg , Heidelberg , Germany
| | - Maren Schuhmann
- a Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL) , University of Heidelberg , Heidelberg , Germany
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Dalar L, Özdemir C, Sökücü SN, Karasulu L, Altın S. Bronchoscopic palliation to treat endobronchial metastasis of the tracheobronchial tree. Respir Investig 2016; 54:116-120. [PMID: 26879481 DOI: 10.1016/j.resinv.2015.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/26/2015] [Accepted: 09/06/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Endobronchial metastases (EBM) are rarely observed, but they are caused by a number of different tumors. Bronchoscopy is the main approach for both differential diagnosis and to maintain endoluminal palliation. In this study, consecutive EBM cases that had been diagnosed and treated were evaluated in a retrospective cohort. METHODS In total, 18 pathologically verified patients with EBM originating from extrathoracic tumors who were referred to our interventional pulmonology unit with respiratory symptoms were retrospectively evaluated. Tumor type, metastasis location, treatment method and frequency, and complications were evaluated. RESULTS In total, there were 18 patients (13 women) with EBM enrolled in this study. All were diagnosed by a bronchial biopsy. The mean age of the patients was 48±15.24 years (range: 24-76 years). The most frequent sites of origin of the metastases were the bone (5) and kidney. Obstructions were observed in the tracheas of 12 patients, in the right main bronchi of 10, and in the left main bronchi of 11. Twelve airway stents were placed in nine patients. The removal of the obstruction was effective in the remaining patients. The mean number of treatment applications was 1.47 (range: 1-3). Hemorrhage, mucostasis, and granulation were observed. The median follow-up duration was 528 days (range: 62-1177 days). The median survival time for the patients who died was 122 days (range: 2-885 days). CONCLUSIONS EBM is rare, and bronchoscopy is the primary method of diagnosis, followed by palliation, if necessary.
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Affiliation(s)
- Levent Dalar
- Istanbul Bilim University, School of Medicine, Department of Pulmonary Medicine, Sisli Florence Nightingale Hospital, Abidei Hurriyet cd. 166, Sisli, Istanbul, Turkey.
| | - Cengiz Özdemir
- Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istasyon Yolu cad, Zeytinburnu, Istanbul, Turkey.
| | - Sinem Nedime Sökücü
- Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istasyon Yolu cad, Zeytinburnu, Istanbul, Turkey.
| | - Levent Karasulu
- Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istasyon Yolu cad, Zeytinburnu, Istanbul, Turkey.
| | - Sedat Altın
- Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istasyon Yolu cad, Zeytinburnu, Istanbul, Turkey.
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Sauvage M, Tiffet O, Vergnon JM. [Tracheobronchial prosthesis in Mounier-Kuhn syndrome: New perspectives]. Rev Mal Respir 2015; 32:519-23. [PMID: 25737189 DOI: 10.1016/j.rmr.2015.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Mounier-Kuhn syndrome or tracheobronchomegaly is a rare congenital condition, the management of which is complex. We report the case of a patient who was treated with interventional endoscopy. OBSERVATION We describe the case of a 74-year-old man with a diagnosis of tracheobronchomegaly who was admitted in 2003 with a background of deteriorating respiratory status and the occurrence of postural syncope. He initially received a tracheobronchial silicone Y prosthesis, extended with metal prostheses at the tracheal and bronchial level. This arrangement remained stable until 2011. He then began to develop episodes of asphyxia related to posterior dislocation of the tracheobronchial prosthesis, after breakage of the metallic mesh tracheal prosthesis. A new tracheobronchial prosthesis Y was then placed, custom-made from a 3D model of the airways. This was clinically and functionally effective. DISCUSSION This case describes the management of a patient with Mounier-Kuhn syndrome by interventional bronchoscopy, with the adaptation of prosthetic materials, on an individual basis, to the anatomy of the patient's airway.
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Affiliation(s)
- M Sauvage
- Service de pneumologie et d'oncologie thoracique, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - O Tiffet
- Service de chirurgie générale et thoracique, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - J-M Vergnon
- Service de pneumologie et d'oncologie thoracique, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France; LINA EA 4624, université Jean Monnet, 42023 Saint-Étienne, France.
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36
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Katoch CDS, Chandran VM, Bhattacharyya D, Barthwal MS. Closure of bronchopleural fistula by interventional bronchoscopy using sealants and endobronchial devices. Med J Armed Forces India 2013; 69:326-9. [PMID: 24600137 DOI: 10.1016/j.mjafi.2013.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 04/22/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bronchopleural fistula (BPF) is a communication in the form of a sinus tract between the pleural space and the bronchial tree. Chronic bronchopleural fistula (BPF) is a rare but a serious complication of several pulmonary and postoperative conditions. BPF carries a high morbidity and mortality and is associated with prolonged hospital stay and thus high resource consumption. Till date surgical intervention has been the main stay of management of chronic BPF. Our study was carried out to study the efficacy of sealants like Bioglue, Tissel glue and endobronchial devices like coils to close the BPFs through bronchoscopic interventions in those cases which failed to close with the conventional treatment regimen and progressed to chronicity. METHOD This study was carried out in a tertiary care hospital. A total 25 patients of chronic BPF/air leaks were selected and subjected to bronchoscopic localization and subsequent intervention using sealants and coils. RESULTS Total 25 patients with chronic BPF were treated with bronchoscopic interventions using glues, and coils.23 patients were males and 2 were females and 14 were postoperative while 11 patients were non operative. Only smaller fistulas were amenable to glues and coils while there was recurrence in patients with larger air leaks requiring surgical intervention. CONCLUSION From this study it is concluded that non-operative bronchoscopic interventions to seal the air leaks are effective only in smaller air leaks i.e. alveolopleural fistula (APF). The larger air leaks like leaking stump and larger bronchopleural fistula have not got long lasting and encouraging results with sealants and endobronchial devices.
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Affiliation(s)
- C D S Katoch
- Senior Advisor (Medicine & Pulmonary Medicine), Military Hospital (Cardio Thoracic Center), Pune-411040, India
| | - V M Chandran
- Associate Professor, Department of Radiology, Armed Forces Medical College, Pune-411040, India
| | - D Bhattacharyya
- Senior Advisor (Medicine & Pulmonary Medicine), Military Hospital (Cardio Thoracic Center), Pune-411040, India
| | - M S Barthwal
- Commandant, Military Hospital Mhow, C/o 56 APO, India
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