Purpose: To report on the utility and the complications of endobronchial cryotherapy on benign tracheobronchial lesions, using flexible fiberoptic bronchoscopy. Methods: This is a case series. Seventeen patients underwent flexible bronchoscopy. Ages ranged from 28 to 70 years. Five patients had a recurring, localizing pneumonia, four had dyspnea, two had hemoptysis, and one had bleeding after endobronchial biopsy. Cough, chest pain, wheeze, or stridor were reported but not recorded. All patients were felt to have an endobronchial lesion responsible for their complaints. Three patients were status-post lung transplant and one was post sleeve resection for carcinoma. All patients underwent flexible fiberoptic bronchoscopy (2.6 mm working channel) following the standard monitoring protocol after routine prebronchoscopy evaluation. Topical airway anesthesia and intravenous sedation with a benzodiazepine and a narcotic were used. Oral or nasal intubation was performed. After the lesion was localized, endobronchial cryotherapy was applied, using the 2.2 mm diameter flexible cryoprobe. Thirty to 60 second application times and repeat freeze-thaw cycles were employed. Tissue or foreign objects were removed when possible. Routine post-bronchoscopy protocol was followed. Follow-up bronchoscopy was done at two week intervals. Results: The findings at bronchoscopy were as follows: four patients had granulation tissue, four had a foreign body- two with a tooth, one a tooth cap and one a chicken bone, two had a lipoma, two had papillomatosis, and one each had a hamartoma, a chondroma, malacoplakia, a blood clot, and bleeding after an endobronchial biopsy. Three of the five pneumonias resolved after tissue removal- two with lipomas, one with malacoplakia- the hamartoma and chondroma were cryoresistant and required surgical intervention. Two of the four patients with dyspnea, both with hemoptysis, and the one with post biopsy bleeding were controlled with cryotherapy. Both teeth and the chicken bone were removed but the tooth cap was not. Endoscopic success was felt to be present in 14 of the 17 cases. No patients died from the procedure. No complications occurred. Conclusions: Endobronchial cryotherapy using flexible bronchoscopy is a relatively successful and safe procedure for some benign tracheobronchial lesions. Clinical Implications: The ability to perform cryotherapy with flexible bronchoscopy, along with the apparent safety and the relative effectiveness of cryotherapy, provide the chest physician with another option in managing endobronchial disease.
|Original language||English (US)|
|Issue number||4 SUPPL.|
|State||Published - Oct 1 1998|
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine