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Erschienen in: Lung 2/2021

17.02.2021 | INTERVENTIONAL PULMONOLOGY

Endobronchial Balloon Blockers: A Retrospective Analysis of Their Implementation for Use in Transbronchial Cryobiopsy Under Conscious Sedation

verfasst von: Kevin F. Deasy, Laura J. Walsh, Marcus P. Kennedy, Michael T. Henry

Erschienen in: Lung | Ausgabe 2/2021

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Abstract

Introduction

Transbronchial lung cryobiopsy (TBLC) is a promising technique that is evolving as a standard diagnostic procedure in the diagnosis of interstitial lung disease. However, there are a variety of non-standardised techniques adopted for this procedure. We aim to describe our approach to TBLC with balloon blockade under conscious sedation (CS).

Methods

We performed a retrospective analysis of patients undergoing TBLC using flexible bronchoscopy under CS in our institution over the calendar years 2017–2018; before and after a transition to the use of endobronchial balloon blockers (EBB) in 2017.

Results

25 patients underwent transbronchial cryobiopsy during the study period. Of these; 12 procedures used EBB. EBB subjects had significantly less moderate or severe airway bleeding (8.3% vs 38.5%) despite higher biopsy rates in the EBB group, 2.9 (2–4) vs 2.4 (1–4) in the non-EBB group. No severe airway bleeding occurred in the EBB group. A multidisciplinary meeting (MDM) confirmed diagnosis was achieved in 88% of patients. 10/12 subjects (83%) in the EBB group and 12/13 subjects (92%) in the non-EBB group (p = 0.5).

Conclusion

Our institution is novel in using EBB as standard during TBLC specifically under CS with flexible bronchoscopy in the bronchoscopy suite. This retrospective analysis demonstrates that EBB enhances the safety profile of performing TBLC under CS and did not appear to impact diagnostic yield or patient safety.
Literatur
1.
Zurück zum Zitat Ravaglia C, Wells AU, Tomassetti S, Gurioli C, Gurioli C, Dubini A, Cavazza A, Colby TV, Piciucchi S, Puglisi S, Bosi M, Poletti V (2019) Diagnostic yield and risk/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: a large cohort of 699 patients. BMC Pulm Med 19(1):16CrossRef Ravaglia C, Wells AU, Tomassetti S, Gurioli C, Gurioli C, Dubini A, Cavazza A, Colby TV, Piciucchi S, Puglisi S, Bosi M, Poletti V (2019) Diagnostic yield and risk/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: a large cohort of 699 patients. BMC Pulm Med 19(1):16CrossRef
2.
Zurück zum Zitat Lentz RJ, Argento AC, Colby TV, Rickman OB, Maldonado F (2017) Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thorac Dis 9(7):2186–2203CrossRef Lentz RJ, Argento AC, Colby TV, Rickman OB, Maldonado F (2017) Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges. J Thorac Dis 9(7):2186–2203CrossRef
3.
Zurück zum Zitat Fruchter O, Fridel L, Rosengarten D, Rahman NA, Kramer MR (2013) Transbronchial cryobiopsy in immunocompromised patients with pulmonary infiltrates: a pilot study. Lung 191(6):619–624CrossRef Fruchter O, Fridel L, Rosengarten D, Rahman NA, Kramer MR (2013) Transbronchial cryobiopsy in immunocompromised patients with pulmonary infiltrates: a pilot study. Lung 191(6):619–624CrossRef
4.
Zurück zum Zitat Fruchter O, Fridel L, Rosengarten D, Raviv Y, Rosanov V, Kramer MR (2013) Transbronchial cryo-biopsy in lung transplantation patients: first report. Respirology 18(4):669–673CrossRef Fruchter O, Fridel L, Rosengarten D, Raviv Y, Rosanov V, Kramer MR (2013) Transbronchial cryo-biopsy in lung transplantation patients: first report. Respirology 18(4):669–673CrossRef
5.
Zurück zum Zitat Fruchter O, Fridel L, El Raouf BA, Abdel-Rahman N, Rosengarten D, Kramer MR (2014) Histological diagnosis of interstitial lung diseases by cryo-transbronchial biopsy. Respirology 19(5):683–688CrossRef Fruchter O, Fridel L, El Raouf BA, Abdel-Rahman N, Rosengarten D, Kramer MR (2014) Histological diagnosis of interstitial lung diseases by cryo-transbronchial biopsy. Respirology 19(5):683–688CrossRef
6.
Zurück zum Zitat Griff S, Schonfeld N, Ammenwerth W, Blum TG, Grah C, Bauer TT, Grüning W, Mairinger T, Wurps H (2014) Diagnostic yield of transbronchial cryobiopsy in non-neoplastic lung disease: a retrospective case series. BMC Pulm Med 14:171CrossRef Griff S, Schonfeld N, Ammenwerth W, Blum TG, Grah C, Bauer TT, Grüning W, Mairinger T, Wurps H (2014) Diagnostic yield of transbronchial cryobiopsy in non-neoplastic lung disease: a retrospective case series. BMC Pulm Med 14:171CrossRef
7.
Zurück zum Zitat Gershman E, Fruchter O, Benjamin F, Nader AR, Rosengarten D, Rusanov V, Fridel L, Kramer MR (2015) Safety of cryo-transbronchial biopsy in diffuse lung diseases: analysis of three hundred cases. Respiration 90(1):40–46CrossRef Gershman E, Fruchter O, Benjamin F, Nader AR, Rosengarten D, Rusanov V, Fridel L, Kramer MR (2015) Safety of cryo-transbronchial biopsy in diffuse lung diseases: analysis of three hundred cases. Respiration 90(1):40–46CrossRef
8.
Zurück zum Zitat Ramaswamy A, Homer R, Killam J, Pisani M, Murphy T, Araujo K, Puchalski J (2016) Comparison of transbronchial and cryobiopsies in evaluation of diffuse parenchymal lung disease. J Bronchol Interv Pulmonol 23(1):14–21CrossRef Ramaswamy A, Homer R, Killam J, Pisani M, Murphy T, Araujo K, Puchalski J (2016) Comparison of transbronchial and cryobiopsies in evaluation of diffuse parenchymal lung disease. J Bronchol Interv Pulmonol 23(1):14–21CrossRef
10.
Zurück zum Zitat Babiak A, Hetzel J, Krishna G, Fritz P, Moeller P, Balli T, Hetzel M (2009) Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 78(2):203–208CrossRef Babiak A, Hetzel J, Krishna G, Fritz P, Moeller P, Balli T, Hetzel M (2009) Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 78(2):203–208CrossRef
11.
Zurück zum Zitat Kropski JA, Pritchett JM, Mason WR, Sivarajan L, Gleaves LA, Johnson JE, Lancaster LH, Lawson WE, Blackwell TS, Steele MP, Loyd JE, Rickman OB (2013) Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease. PLoS ONE 8(11):e78674CrossRef Kropski JA, Pritchett JM, Mason WR, Sivarajan L, Gleaves LA, Johnson JE, Lancaster LH, Lawson WE, Blackwell TS, Steele MP, Loyd JE, Rickman OB (2013) Bronchoscopic cryobiopsy for the diagnosis of diffuse parenchymal lung disease. PLoS ONE 8(11):e78674CrossRef
12.
Zurück zum Zitat Casoni GL, Tomassetti S, Cavazza A, Colby TV, Dubini A, Ryu JH, Carretta E, Tantalocco P, Piciucchi S, Ravaglia C et al (2014) Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. PLoS ONE 9(2):e86716CrossRef Casoni GL, Tomassetti S, Cavazza A, Colby TV, Dubini A, Ryu JH, Carretta E, Tantalocco P, Piciucchi S, Ravaglia C et al (2014) Transbronchial lung cryobiopsy in the diagnosis of fibrotic interstitial lung diseases. PLoS ONE 9(2):e86716CrossRef
13.
Zurück zum Zitat Pajares V, Puzo C, Castillo D, Lerma E, Montero MA, Ramos-Barbón D, Amor-Carro O, Gil de Bernabé A, Franquet T, Plaza V, Hetzel J, Sanchis J, Torrego A (2014) Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology 19(6):900–906CrossRef Pajares V, Puzo C, Castillo D, Lerma E, Montero MA, Ramos-Barbón D, Amor-Carro O, Gil de Bernabé A, Franquet T, Plaza V, Hetzel J, Sanchis J, Torrego A (2014) Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology 19(6):900–906CrossRef
14.
Zurück zum Zitat Hagmeyer L, Theegarten D, Treml M, Priegnitz C, Randerath W (2016) Validation of transbronchial cryobiopsy in interstitial lung disease—interim analysis of a prospective trial and critical review of the literature. Sarcoidosis Vasc Diffuse Lung Dis 33(1):2–9PubMed Hagmeyer L, Theegarten D, Treml M, Priegnitz C, Randerath W (2016) Validation of transbronchial cryobiopsy in interstitial lung disease—interim analysis of a prospective trial and critical review of the literature. Sarcoidosis Vasc Diffuse Lung Dis 33(1):2–9PubMed
15.
Zurück zum Zitat Hagmeyer L, Theegarten D, Wohlschlager J, Treml M, Matthes S, Priegnitz C, Randerath WJ (2016) The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung disease. Clin Respir J 10(5):589–595CrossRef Hagmeyer L, Theegarten D, Wohlschlager J, Treml M, Matthes S, Priegnitz C, Randerath WJ (2016) The role of transbronchial cryobiopsy and surgical lung biopsy in the diagnostic algorithm of interstitial lung disease. Clin Respir J 10(5):589–595CrossRef
16.
Zurück zum Zitat Pourabdollah M, Shamaei M, Karimi S, Karimi M, Kiani A, Jabbari HR (2016) Transbronchial lung biopsy: the pathologist’s point of view. Clin Respir J 10(2):211–216CrossRef Pourabdollah M, Shamaei M, Karimi S, Karimi M, Kiani A, Jabbari HR (2016) Transbronchial lung biopsy: the pathologist’s point of view. Clin Respir J 10(2):211–216CrossRef
17.
Zurück zum Zitat Ravaglia C, Bonifazi M, Wells AU, Tomassetti S, Gurioli C, Piciucchi S, Dubini A, Tantalocco P, Sanna S, Negri E et al (2016) Safety and diagnostic yield of transbronchial lung cryobiopsy in diffuse parenchymal lung diseases: a comparative study versus video-assisted thoracoscopic lung biopsy and a systematic review of the literature. Respiration 91(3):215–227CrossRef Ravaglia C, Bonifazi M, Wells AU, Tomassetti S, Gurioli C, Piciucchi S, Dubini A, Tantalocco P, Sanna S, Negri E et al (2016) Safety and diagnostic yield of transbronchial lung cryobiopsy in diffuse parenchymal lung diseases: a comparative study versus video-assisted thoracoscopic lung biopsy and a systematic review of the literature. Respiration 91(3):215–227CrossRef
18.
Zurück zum Zitat Tomassetti S, Wells AU, Costabel U, Cavazza A, Colby TV, Rossi G, Sverzellati N, Carloni A, Carretta E, Buccioli M, Tantalocco P et al (2016) Bronchoscopic lung cryobiopsy increases diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 193(7):745–752CrossRef Tomassetti S, Wells AU, Costabel U, Cavazza A, Colby TV, Rossi G, Sverzellati N, Carloni A, Carretta E, Buccioli M, Tantalocco P et al (2016) Bronchoscopic lung cryobiopsy increases diagnostic confidence in the multidisciplinary diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 193(7):745–752CrossRef
19.
Zurück zum Zitat Ravaglia C, Wells AU, Tomassetti S et al (2017) Transbronchial lung cryobiopsy in diffuse parenchymal lung disease: comparison between biopsy from 1 segment and biopsy from 2 segments—diagnostic yield and complications. Respiration 93(4):285–292CrossRef Ravaglia C, Wells AU, Tomassetti S et al (2017) Transbronchial lung cryobiopsy in diffuse parenchymal lung disease: comparison between biopsy from 1 segment and biopsy from 2 segments—diagnostic yield and complications. Respiration 93(4):285–292CrossRef
20.
Zurück zum Zitat Sriprasart T, Aragaki A, Baughman R, Wikenheiser-Brokamp K, Khanna G, Tanase D, Kirschner M, Benzaquen S (2017) A single US center experience of transbronchial lung cryobiopsy for diagnosing interstitial lung disease with a 2-scope technique. J Bronchol Interv Pulmonol 24(2):131–135CrossRef Sriprasart T, Aragaki A, Baughman R, Wikenheiser-Brokamp K, Khanna G, Tanase D, Kirschner M, Benzaquen S (2017) A single US center experience of transbronchial lung cryobiopsy for diagnosing interstitial lung disease with a 2-scope technique. J Bronchol Interv Pulmonol 24(2):131–135CrossRef
21.
Zurück zum Zitat Ussavarungsi K, Kern RM, Roden AC, Ryu JH, Edell ES (2017) Transbronchial cryobiopsy in diffuse parenchymal lung disease: retrospective analysis of 74 cases. Chest 151(2):400–408CrossRef Ussavarungsi K, Kern RM, Roden AC, Ryu JH, Edell ES (2017) Transbronchial cryobiopsy in diffuse parenchymal lung disease: retrospective analysis of 74 cases. Chest 151(2):400–408CrossRef
22.
Zurück zum Zitat Yarmus L, Akulian J, Gilbert C, Illei P, Shah P, Merlo C, Ores J, Feller-Kopman D (2013) Cryoprobe transbronchial lung biopsy in patients after lung transplantation: a pilot safety study. Chest 143(3):621–626CrossRef Yarmus L, Akulian J, Gilbert C, Illei P, Shah P, Merlo C, Ores J, Feller-Kopman D (2013) Cryoprobe transbronchial lung biopsy in patients after lung transplantation: a pilot safety study. Chest 143(3):621–626CrossRef
23.
Zurück zum Zitat Echevarria-Uraga JJ, Perez-Izquierdo J, Garcia-Garai N, Gómez-Jiménez E, Aramburu-Ojembarrena A, Tena-Tudanca L, Miguélez-Vidales JL, Capelastegui-Saiz A (2016) Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy. Respirology 21(6):1094–1099CrossRef Echevarria-Uraga JJ, Perez-Izquierdo J, Garcia-Garai N, Gómez-Jiménez E, Aramburu-Ojembarrena A, Tena-Tudanca L, Miguélez-Vidales JL, Capelastegui-Saiz A (2016) Usefulness of an angioplasty balloon as selective bronchial blockade device after transbronchial cryobiopsy. Respirology 21(6):1094–1099CrossRef
24.
Zurück zum Zitat Berim IG, Saeed AI, Awab A, Highley A, Colanta A, Chaudry F (2017) Radial probe ultrasound-guided cryobiopsy. J Bronchol Interv Pulmonol 24(2):170–173CrossRef Berim IG, Saeed AI, Awab A, Highley A, Colanta A, Chaudry F (2017) Radial probe ultrasound-guided cryobiopsy. J Bronchol Interv Pulmonol 24(2):170–173CrossRef
25.
Zurück zum Zitat Kronborg-White S, Folkersen B, Rasmussen TR, Voldby N, Madsen LB, Rasmussen F, Poletti V, Bendstrup E (2017) Introduction of cryobiopsies in the diagnostics of interstitial lung diseases—experiences in a referral center. Eur Clin Respir J 4(1):1274099CrossRef Kronborg-White S, Folkersen B, Rasmussen TR, Voldby N, Madsen LB, Rasmussen F, Poletti V, Bendstrup E (2017) Introduction of cryobiopsies in the diagnostics of interstitial lung diseases—experiences in a referral center. Eur Clin Respir J 4(1):1274099CrossRef
26.
Zurück zum Zitat Troy LK, Grainge C, Corte TJ, Williamson JP, Vallely MP, Cooper WA, Mahar A, Myers JL, Lai S, Mulyadi E, Torzillo PJ et al (2020) Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective comparative study. Lancet Respir Med 8(2):171–181CrossRef Troy LK, Grainge C, Corte TJ, Williamson JP, Vallely MP, Cooper WA, Mahar A, Myers JL, Lai S, Mulyadi E, Torzillo PJ et al (2020) Diagnostic accuracy of transbronchial lung cryobiopsy for interstitial lung disease diagnosis (COLDICE): a prospective comparative study. Lancet Respir Med 8(2):171–181CrossRef
27.
Zurück zum Zitat Hetzel J, Eberhardt R, Petermann C, Wells AU, Colby TV, Tomassetti S, Ryu JH, Fruchter O, Piciucchi S, Dubini A et al (2019) Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease—a prospective, randomized, multicentre cross-over trial. Respir Res 20(1):140CrossRef Hetzel J, Eberhardt R, Petermann C, Wells AU, Colby TV, Tomassetti S, Ryu JH, Fruchter O, Piciucchi S, Dubini A et al (2019) Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease—a prospective, randomized, multicentre cross-over trial. Respir Res 20(1):140CrossRef
28.
Zurück zum Zitat Maldonado F, Danoff SK, Wells AU, Colby TV, Ryu JH, Liberman M, Wahidi MM, Frazer L, Hetzel J, Rickman OB et al (2020) Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases CHEST guideline and expert panel report. Chest 157(4):1030–1042CrossRef Maldonado F, Danoff SK, Wells AU, Colby TV, Ryu JH, Liberman M, Wahidi MM, Frazer L, Hetzel J, Rickman OB et al (2020) Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases CHEST guideline and expert panel report. Chest 157(4):1030–1042CrossRef
29.
Zurück zum Zitat Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, Mandal S, Martin J, Mills J, Navani N, Rahman NM, Wrightson JM, Munavvar M (2013) British thoracic society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 68(Suppl 1):i1CrossRef Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, Mandal S, Martin J, Mills J, Navani N, Rahman NM, Wrightson JM, Munavvar M (2013) British thoracic society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 68(Suppl 1):i1CrossRef
30.
Zurück zum Zitat Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. BMJ 2(5920):656–659CrossRef Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. BMJ 2(5920):656–659CrossRef
31.
Zurück zum Zitat Hernandez-Gonzalez F, Lucena CM, Ramirez J, Sánchez M, Jimenez MJ, Xaubet A, Sellares J, Agustí C (2015) Cryobiopsy in the diagnosis of diffuse interstitial lung disease: yield and cost-effectiveness analysis. Arch Bronconeumol 51(6):261–267CrossRef Hernandez-Gonzalez F, Lucena CM, Ramirez J, Sánchez M, Jimenez MJ, Xaubet A, Sellares J, Agustí C (2015) Cryobiopsy in the diagnosis of diffuse interstitial lung disease: yield and cost-effectiveness analysis. Arch Bronconeumol 51(6):261–267CrossRef
32.
Zurück zum Zitat DiBardino DM, Haas AR, Lanfranco AR, Litzky LA, Sterman D, Bessich JL (2017) High complication rate after introduction of transbronchial cryobiopsy into clinical practice at an academic medical center. Ann Am Thorac Soc 14(6):851–857CrossRef DiBardino DM, Haas AR, Lanfranco AR, Litzky LA, Sterman D, Bessich JL (2017) High complication rate after introduction of transbronchial cryobiopsy into clinical practice at an academic medical center. Ann Am Thorac Soc 14(6):851–857CrossRef
33.
Zurück zum Zitat Poletti V, Hetzel J (2015) Transbronchial cryobiopsy in diffuse parenchymal lung disease: need for procedural standardization. Respiration 90(4):275–278CrossRef Poletti V, Hetzel J (2015) Transbronchial cryobiopsy in diffuse parenchymal lung disease: need for procedural standardization. Respiration 90(4):275–278CrossRef
34.
Zurück zum Zitat Griff S, Ammenwerth W, Schonfeld N, Bauer TT, Mairinger T, Blum TG, Kollmeier J, Grüning W (2011) Morphometrical analysis of transbronchial cryobiopsies. Diagn Pathol 6:53CrossRef Griff S, Ammenwerth W, Schonfeld N, Bauer TT, Mairinger T, Blum TG, Kollmeier J, Grüning W (2011) Morphometrical analysis of transbronchial cryobiopsies. Diagn Pathol 6:53CrossRef
Metadaten
Titel
Endobronchial Balloon Blockers: A Retrospective Analysis of Their Implementation for Use in Transbronchial Cryobiopsy Under Conscious Sedation
verfasst von
Kevin F. Deasy
Laura J. Walsh
Marcus P. Kennedy
Michael T. Henry
Publikationsdatum
17.02.2021
Verlag
Springer US
Erschienen in
Lung / Ausgabe 2/2021
Print ISSN: 0341-2040
Elektronische ISSN: 1432-1750
DOI
https://doi.org/10.1007/s00408-021-00424-y

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