1
|
Nadzir M, Marhana IA, Fatmawati F. Fatal airway obstruction due to endobronchial bleeding post cryobiopsy: a case report. J Surg Case Rep 2025; 2025:rjaf231. [PMID: 40255328 PMCID: PMC12008113 DOI: 10.1093/jscr/rjaf231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Accepted: 03/28/2025] [Indexed: 04/22/2025] Open
Abstract
Cryobiopsy offers an advantage because of the extraction of more extensive tissue and enhanced diagnostic accuracy. However, the risk of bleeding from the biopsy site is higher. We report a lung tumor patient who experienced bleeding in the right main bronchus after cryobiopsy. Suctioning was performed, cold saline was administered, and the bleeding stopped. Five minutes after the procedure, the patient experienced desaturation. A re-bronchoscopy found massive bleeding in the right main bronchus which spread to the left main bronchus. Suctioning was performed, cold saline and epinephrine were administered. Before further treatment was given, the patient got cardiac arrest and he was treated in the intensive care unit. This highlighted the importance of training and considering the additional precautions for bleeding control. Intensive monitoring of the patients is needed when performing cryobiopsy to prepare for the early management of complications, especially for those patients with risk factors for bleeding in cryobiopsy.
Collapse
Affiliation(s)
- Muhammad Nadzir
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University – Dr. Soetomo General Academic Hospital, Jl. Mayjen Prof. Dr. Moesto po No. 6-8, Surabaya 60286, Indonesia
| | - Isnin Anang Marhana
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University – Dr. Soetomo General Academic Hospital, Jl. Mayjen Prof. Dr. Moesto po No. 6-8, Surabaya 60286, Indonesia
| | - Farah Fatmawati
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University – Dr. Soetomo General Academic Hospital, Jl. Mayjen Prof. Dr. Moesto po No. 6-8, Surabaya 60286, Indonesia
| |
Collapse
|
2
|
Kho SS, Chai CS, Ismail AM. Modified two-scope technique for transbronchial lung cryobiopsy of peripheral pulmonary lesions. Respirol Case Rep 2024; 12:e01450. [PMID: 39130086 PMCID: PMC11317175 DOI: 10.1002/rcr2.1450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/30/2024] [Indexed: 08/13/2024] Open
Abstract
Bleeding mitigation is an important part of any transbronchial lung cryobiopsy (TBLC) procedure, either for interstitial lung disease (ILD) or peripheral pulmonary lesions (PPL). The two-scope technique has been previously described for ILD and PPL-TBLC, but it has its own limitations and technical and logistical complexities. In this case series, we describe a modified two-scope technique that enhances the conventional two-scope technique by maintaining a small equipment footprint and longer bronchoscopic vision without the need for intra-procedure switching of bronchoscopes. Three cases of PPLs were navigated by standard radial endobronchial ultrasound and biopsied with the 1.1 mm flexible ultrathin cryoprobe. All cases achieved a conclusive diagnosis with adequate specimens for immunohistochemical staining and molecular analysis; only Grade 1 bleeding reported in two cases. The challenges and limitations of this modified two-scope technique were also explored in this series.
Collapse
Affiliation(s)
- Sze Shyang Kho
- Division of Respiratory Medicine, Department of MedicineSarawak General Hospital, Ministry of Health MalaysiaKuchingMalaysia
| | - Chan Sin Chai
- Division of Respiratory Medicine, Department of MedicineSarawak General Hospital, Ministry of Health MalaysiaKuchingMalaysia
| | - Adam Malik Ismail
- Department of PathologySarawak General Hospital, Ministry of Health MalaysiaKuchingMalaysia
| |
Collapse
|
3
|
Oki M. Ultrathin bronchoscopy for diagnosing peripheral pulmonary lesions. Respir Investig 2023; 61:711-719. [PMID: 37708637 DOI: 10.1016/j.resinv.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 09/16/2023]
Abstract
Bronchoscopes are continuously improving. Increasingly, thinner bronchoscopes with larger working channels and better imaging quality are becoming available for clinical use. Concurrently, useful ancillary devices have been developed, such as radial probe endobronchial ultrasound (rEBUS) and navigation devices. Randomized studies have demonstrated the diagnostic superiority of ultrathin bronchoscopy over thin bronchoscopy under rEBUS and virtual bronchoscopic navigation guidance for small, peripheral pulmonary lesions. Furthermore, biopsy needles and cryoprobes have been miniaturized and adapted to the working channel of the new ultrathin bronchoscopes. Multi-modality and multi-instrumental ultrathin bronchoscopy using such new technologies has facilitated high diagnostic yields.
Collapse
Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-000, Japan.
| |
Collapse
|
4
|
Oki M, Saka H, Kogure Y, Niwa H, Yamada A, Torii A, Kitagawa C. Ultrathin bronchoscopic cryobiopsy of peripheral pulmonary lesions. Respirology 2023; 28:143-151. [PMID: 36066209 DOI: 10.1111/resp.14360] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Ultrathin bronchoscopy aids in the diagnosis of peripheral pulmonary lesions. However, both the working channel and the specimens are small. A 1.1-mm ultrathin cryoprobe that can enter the working channel of the ultrathin bronchoscope is now available, which may overcome the limitations of small specimen size. The aim of this study was to evaluate the feasibility, efficacy and safety of ultrathin bronchoscopic cryobiopsy using an ultrathin cryoprobe for diagnosing peripheral pulmonary lesions. METHODS Patients with peripheral pulmonary lesions ≤30 mm in diameter were prospectively enrolled in the study. All patients underwent forceps biopsy followed by cryobiopsy using a 3.0-mm ultrathin bronchoscope under radial probe endobronchial ultrasound guidance, virtual bronchoscopic navigation and fluoroscopic guidance. The primary endpoint was the feasibility of cryobiopsy. RESULTS In total, 50 patients with peripheral pulmonary lesions were enrolled in the study; the median longest diameter on computed tomography was 17.9 mm. Cryobiopsy was performed successfully in 49 patients (98%). Forceps biopsy, cryobiopsy and the combination of these two methods provided a specific diagnosis in 54% (27/50), 62% (31/50) and 74% (37/50) of patients, respectively. The median size of specimens obtained via cryobiopsy was significantly larger than the median size obtained via forceps biopsy (7.0 vs. 1.3 mm2 , respectively, p < 0.001). Mild bleeding during cryobiopsy occurred in 47 patients (94%). No moderate/severe bleeding or pneumothorax occurred. CONCLUSION Ultrathin bronchoscopic cryobiopsy is feasible, effective and sufficiently safe for the diagnosis of peripheral pulmonary lesions.
Collapse
Affiliation(s)
- Masahide Oki
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan.,Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan
| | - Yoshihito Kogure
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Hideyuki Niwa
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Arisa Yamada
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Atsushi Torii
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Chiyoe Kitagawa
- Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| |
Collapse
|
5
|
Oki M, Saka H, Kogure Y, Niwa H, Ishida A, Yamada A, Torii A, Kitagawa C. Thin bronchoscopic cryobiopsy using a nasobronchial tube. BMC Pulm Med 2022; 22:361. [PMID: 36153576 PMCID: PMC9508729 DOI: 10.1186/s12890-022-02166-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/19/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Transbronchial lung cryobiopsy is useful when diagnosing lung lesions. However, prevention of associated bleeding complications is essential. This study aimed to evaluate the safety and efficacy of our novel bronchoscopic cryobiopsy technique, which uses a long nasobronchial tube to prevent blood flooding the central airway. METHODS Patients with localized or diffuse lung lesions were prospectively enrolled and underwent cryobiopsy using a 1.9 mm diameter cryoprobe and a 4.0 mm diameter thin bronchoscope under conscious sedation. For cryobiopsy, a long silicone tube (inner diameter, 5.0 mm) was advanced through the nose to the target bronchus, then wedged to drain blood under thin-tube bronchoscopic control. The primary endpoint was the frequency of bleeding complications. RESULTS Of the 80 patients initially enrolled, 73 that underwent at least one cryobiopsy were ultimately included. Mild bleeding during cryobiopsy occurred in 58 patients (79.5%), but there was no moderate or severe bleeding. Other complications occurred in four patients (two pneumothorax, one pneumomediastinum, and one pneumonia). Tube dislocation was noted in eight patients (11%). Cryobiopsy specimens were significantly larger than forceps biopsy specimens (9.0 mm2 vs. 2.7 mm2, P < .001) and allowed specific diagnoses in 50 patients (68.5%). CONCLUSIONS Thin bronchoscopic cryobiopsy using a nasobronchial tube in consciously sedated patients is safe and effective. Trial registration Date of registration: 24/06/2019. UMIN-Clinical Trials Registry; Identifier: UMIN000037156 https://www.umin.ac.jp/ctr/index.htm.
Collapse
Affiliation(s)
- Masahide Oki
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Hideo Saka
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan ,grid.416589.70000 0004 0640 6976Department of Respiratory Medicine, Matsunami General Hospital, Gifu, Japan
| | - Yoshihito Kogure
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Hideyuki Niwa
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Akane Ishida
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Arisa Yamada
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Atsushi Torii
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| | - Chiyoe Kitagawa
- grid.410840.90000 0004 0378 7902Department of Respiratory Medicine, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, 460-0001 Japan
| |
Collapse
|
6
|
Takada K, Imabayashi T, Matsumoto Y, Uchimura K, Furuse H, Nishimatsu K, Tsuchida T. Feasibility of the modified balloon occlusion method using a 6-Fr balloon catheter in transbronchial lung cryobiopsy. Respir Investig 2022; 60:425-429. [PMID: 35367153 DOI: 10.1016/j.resinv.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Transbronchial lung cryobiopsy (TBLC) is useful for diagnosing diffuse parenchymal lung diseases (DPLD). To prevent bleeding during TBLC, the balloon occlusion method has been recommended. However, displacement can occur occasionally, especially with a 4-Fr balloon. We aimed to investigate whether the use of a 6-Fr balloon would allow tamponade at a more proximal position and decrease balloon displacement in TBLC under flexible bronchoscopy. METHODS We retrospectively reviewed 20 patients with DPLD who underwent TBLC using the modified balloon occlusion method between June 2019 and May 2021. RESULTS The median number of TBLCs was three (range, 2-5). The most common balloon placement site was the right basal bronchus (14 patients). Mild and moderate bleeding was seen in 10 patients each. Successful balloon occlusion was achieved in all patients without dislocation. CONCLUSION The modified balloon occlusion method in TBLC under flexible bronchoscopy might be a reasonable option for bleeding prevention.
Collapse
Affiliation(s)
- Kohei Takada
- Department of Endoscopy, Respiratory Endoscopy Division. National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan; Department of Respiratory Medicine, Japanese Red Cross Medical Center, Japan
| | - Tatsuya Imabayashi
- Department of Endoscopy, Respiratory Endoscopy Division. National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan.
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division. National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan; Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan
| | - Keigo Uchimura
- Department of Endoscopy, Respiratory Endoscopy Division. National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan
| | - Hideaki Furuse
- Department of Endoscopy, Respiratory Endoscopy Division. National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan
| | - Kanako Nishimatsu
- Department of Endoscopy, Respiratory Endoscopy Division. National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division. National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo, Tokyo, 104-0045, Japan
| |
Collapse
|