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

  • INTERVENTIONAL PULMONOLOGY
  • Published:
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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.

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Data Availability

Date is available from the corresponding author on reasonable request.

References

  1. 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):16

    Article  Google Scholar 

  2. 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):2186–2203

    Article  Google Scholar 

  3. 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):619–624

    Article  Google Scholar 

  4. 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):669–673

    Article  Google Scholar 

  5. 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):683–688

    Article  Google Scholar 

  6. 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 14:171

    Article  Google Scholar 

  7. 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):40–46

    Article  Google Scholar 

  8. 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):14–21

    Article  Google Scholar 

  9. Bango-Álvarez A, Ariza-Prota M, Torres-Rivas H, Fernández-Fernández L, Prieto A, Sánchez I, Gil M, Pando-Sandoval A (2017) Transbronchial cryobiopsy in interstitial lung disease: experience in 106 cases—how to do it. ERJ Open Res. https://doi.org/10.1183/23120541.00148-2016

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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):203–208

    Article  Google Scholar 

  11. 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):e78674

    Article  CAS  Google Scholar 

  12. 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):e86716

    Article  Google Scholar 

  13. 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):900–906

    Article  Google Scholar 

  14. 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):2–9

    PubMed  Google Scholar 

  15. 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):589–595

    Article  Google Scholar 

  16. 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):211–216

    Article  Google Scholar 

  17. 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):215–227

    Article  Google Scholar 

  18. 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):745–752

    Article  Google Scholar 

  19. 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):285–292

    Article  Google Scholar 

  20. 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):131–135

    Article  Google Scholar 

  21. 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):400–408

    Article  Google Scholar 

  22. 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):621–626

    Article  Google Scholar 

  23. 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):1094–1099

    Article  Google Scholar 

  24. Berim IG, Saeed AI, Awab A, Highley A, Colanta A, Chaudry F (2017) Radial probe ultrasound-guided cryobiopsy. J Bronchol Interv Pulmonol 24(2):170–173

    Article  Google Scholar 

  25. 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):1274099

    Article  Google Scholar 

  26. 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):171–181

    Article  CAS  Google Scholar 

  27. 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):140

    Article  Google Scholar 

  28. 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):1030–1042

    Article  Google Scholar 

  29. 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):i1

    Article  Google Scholar 

  30. Ramsay MA, Savege TM, Simpson BR, Goodwin R (1974) Controlled sedation with alphaxalone-alphadolone. BMJ 2(5920):656–659

    Article  CAS  Google Scholar 

  31. 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):261–267

    Article  Google Scholar 

  32. 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):851–857

    Article  Google Scholar 

  33. Poletti V, Hetzel J (2015) Transbronchial cryobiopsy in diffuse parenchymal lung disease: need for procedural standardization. Respiration 90(4):275–278

    Article  Google Scholar 

  34. Griff S, Ammenwerth W, Schonfeld N, Bauer TT, Mairinger T, Blum TG, Kollmeier J, Grüning W (2011) Morphometrical analysis of transbronchial cryobiopsies. Diagn Pathol 6:53

    Article  Google Scholar 

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, Cork University Hospital, Cork, T12F2DT, Ireland

    Kevin F. Deasy, Laura J. Walsh, Marcus P. Kennedy & Michael T. Henry

  2. Faculty of Medicine, University College Cork, Cork, Ireland

    Marcus P. Kennedy & Michael T. Henry

Authors
  1. Kevin F. Deasy
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  2. Laura J. Walsh
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  3. Marcus P. Kennedy
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  4. Michael T. Henry
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Contributions

Conceptualization: MTH, MPK. Data curation: LJW, KFD. Formal analysis: MTH, KFD. Investigation: MTH, MPK. Methodology: MTH, MPK, LJW, KFD. Project administration: MTH, LJW, KFD. Writing—original draft: KFD, LJW. Writing—review and editing: MTH, MPK.

Corresponding author

Correspondence to Michael T. Henry.

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The authors declare that they have no conflicts of interest, financial or otherwise, related to this study. They are prepared to sign conflicts of interest forms to this effect.

Ethical Approval

This study protocol was approved by the regional Clinical Research Ethics Committee of Cork University Hospital.

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Deasy, K.F., Walsh, L.J., Kennedy, M.P. et al. Endobronchial Balloon Blockers: A Retrospective Analysis of Their Implementation for Use in Transbronchial Cryobiopsy Under Conscious Sedation. Lung 199, 187–193 (2021). https://doi.org/10.1007/s00408-021-00424-y

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  • DOI: https://doi.org/10.1007/s00408-021-00424-y

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