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Halawa ARR, Farooq S, Amjad MA, Jani PP, Cherian SV. Role of interventional pulmonology in intensive care units: A scoping review. World J Crit Care Med 2025; 14:99654. [DOI: 10.5492/wjccm.v14.i2.99654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 10/31/2024] [Accepted: 12/23/2024] [Indexed: 02/27/2025] Open
Abstract
Interventional pulmonology (IP) represents a rapidly growing and developing subspecialty within pulmonary medicine. To the intensivist, given the elaborate undertakings with respect to airway, lung and pleural disease management-IP has shown an increasing presence and remain a major ally in the care of these patients. Thus, an understanding of the different roles that IP could offer to the intensivist is of prime importance in the multi-disciplinary care of the complex patients within the intensive care units, particularly in relation to lung, airway and pleural diseases. This review article will explore the different intersections of IP in critical care and discuss the applications of this discipline within the highly complex critical care environment.
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Affiliation(s)
- Abdul Rahman R Halawa
- Department of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston, TX 77030, United States
| | - Saad Farooq
- Department of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston, TX 77030, United States
| | - Mohammad Asim Amjad
- Department of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston, TX 77030, United States
| | - Pushan P Jani
- Department of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston, TX 77030, United States
| | - Sujith V Cherian
- Department of Critical Care, Pulmonary and Sleep Medicine, University of Texas Health-McGovern Medical School, Houston, TX 77030, United States
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2
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Santos Portela AM, Radu DM, Onorati I, Peretti M, Freynet O, Uzunhan Y, Jerbi S, Martinod E. [Interventionnal bronchoscopy for the treatment of tracheobronchomalacia]. Rev Mal Respir 2023; 40:700-715. [PMID: 37714754 DOI: 10.1016/j.rmr.2023.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/18/2023] [Indexed: 09/17/2023]
Abstract
Tracheobronchomalacia is usually characterized by more than 50% expiratory narrowing in diameter of the trachea and the bronchi. The expiratory collapse includes two entities: (1) the TBM related to the weakness of the cartilaginous rings, and (2) the Excessive Dynamic Airway Collapse (EDAC) due to the excessive bulging of the posterior membrane. Patients have nonspecific respiratory symptoms like dyspnea and cough. Diagnosis is confirmed by dynamic tests: flexible bronchoscopy and/or computed tomographic scan of the chest. There are different forms of tracheobronchomalacia in adults: primary (genetic, idiopathic) or secondary to trauma, tracheotomy, intubation, surgery, transplantation, emphysema, infection, inflammation, chronic bronchitis, extrinsic compression; or undiagnosed in childhood vascular rings. Some management algorithms have been proposed, but no specific recommendation was established. Only symptomatic patients should be treated. Medical treatments and noninvasive positive pressure ventilation should be the first line therapy, after evaluation of various quality measures (functional status, performance status, dyspnea and quality of life scores). If symptoms persist, therapeutic bronchoscopy permits: (1) patient's selection by stent trial to determine whether patient benefit for surgical airway stabilization; (2) malacic airways stenting in patients who are not surgical candidates, improving QOL despite a high complication rate; (3) the management of stent-related complication (obstruction, plugging, migration granuloma); (4) alternative therapeutics like thermo-ablative solution. Lasty, the development of new types of stents would reduce the complication rates. These different options remained discussed.
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Affiliation(s)
- A M Santos Portela
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - D M Radu
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - I Onorati
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - M Peretti
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - O Freynet
- Département de pneumologie, faculté de Médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - Y Uzunhan
- Département de pneumologie, faculté de Médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - S Jerbi
- Département d'anesthésie, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France
| | - E Martinod
- Département de chirurgie thoracique et vasculaire, faculté de médecine SMBH, Assistance publique-Hôpitaux de Paris, hôpitaux universitaires Paris Seine-Saint-Denis, hôpital Avicenne, université Sorbonne Paris Nord, Bobigny, France.
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Emhmed Ali S, Bhakta A, Bautista RM, Sherif A, Frandah W. Endoscopic stricturotomy with pulsed argon plasma and balloon dilation for refractory benign colorectal strictures: a case series. Transl Gastroenterol Hepatol 2022; 7:32. [PMID: 35892059 PMCID: PMC9257539 DOI: 10.21037/tgh.2020.03.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/16/2020] [Indexed: 01/31/2024] Open
Abstract
Benign strictures of the colon and rectum affect a sizable portion of patients who have an underlying inflammatory disease or who have undergone recent surgery. Etiologies include inflammatory bowel disease (IBD), post-surgical ischemia, anastomotic strictures, non-steroidal anti-inflammatory drugs (NSAIDs), and complicated diverticulitis. Refractory colorectal strictures are very difficult to manage and often require repeated and different treatment options. We report a novel technique using argon plasma coagulation (APC) with endoscopic balloon dilation (EBD) as a safe and effective treatment modality for refractory benign colorectal strictures. Four patients with symptomatic benign colorectal strictures were referred for endoscopic treatment. In all cases (two females and two males; average age 62 years), the endoscopic and radiographic assessment showed significant strictures (diameter, 4-13 mm). The stricture was secondary to Crohn's disease in one patient and anastomotic strictures in the other three patients. Endoscopic stricturotomy through fulguration and tissue destruction using argon plasma at 1.5 liters/minute, effect 2, and 40 watts was performed, followed by EBD. All patients were treated by one advanced endoscopist. The primary outcomes were the efficiency and safety of endoscopic stricturotomy with pulsed argon plasma and balloon dilation. The resolution of stricture was achieved in all patients. No complications were reported. We believe that combined APC with EBD is a safe and effective technique in the treatment of benign colonic stricture.
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Affiliation(s)
- Saad Emhmed Ali
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - Avinash Bhakta
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Ahmed Sherif
- Department of Medicine, University of Kentucky, Lexington, KY, USA
| | - Wesam Frandah
- Department of Medicine, University of Kentucky, Lexington, KY, USA
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4
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Wang F, Wu Y, Yao X, Chen S, Liu H. Surgical Treatment of Primary Tracheal Adenoid Cystic Carcinoma. EAR, NOSE & THROAT JOURNAL 2022:1455613221111497. [PMID: 35786025 DOI: 10.1177/01455613221111497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Primary tracheal adenoid cystic carcinoma (TACC) occurring in the cervical trachea and invading the thyroid is very rare. Surgical resection and airway reconstruction are the main treatment methods, and other treatments include radiotherapy and endoscopic intervention. Herein, we present the case of a 74-year-old female patient with TACC. The patient underwent surgery and postoperative pathology showed that the tumor invaded the adventitia of the trachea and bilateral thyroid, where nerve involvement was observed. The patient recovered well after the operation without adjuvant therapy. Eight months after the operation, Computed tomography showed that the trachea was unobstructed and there was no recurrence.
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Affiliation(s)
- Feng Wang
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Yu Wu
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xiyu Yao
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Shunjin Chen
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Hui Liu
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fuzhou, China
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Shaller BD, Filsoof D, Pineda JM, Gildea TR. Malignant Central Airway Obstruction: What's New? Semin Respir Crit Care Med 2022; 43:512-529. [PMID: 35654419 DOI: 10.1055/s-0042-1748187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and limited when compared with other branches of interventional pulmonary medicine (e.g., the early diagnosis of peripheral lung nodules). Indeed, one pragmatic, albeit somewhat uncharitable, reading of this article's title might suggest a wry smile and shug of the shoulders as to imply that relatively little has changed in recent years. That said, the spectrum of interventions for MCAO continues to expand, even if at a less impressive clip. Herein, we present on MCAO and its endoscopic and nonendoscopic management-that which is old, that which is new, and that which is still on the horizon.
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Affiliation(s)
- Brian D Shaller
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Darius Filsoof
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
| | - Jorge M Pineda
- Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California
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Ho E, Wagh A, Hogarth K, Murgu S. Single-Use and Reusable Flexible Bronchoscopes in Pulmonary and Critical Care Medicine. Diagnostics (Basel) 2022; 12:174. [PMID: 35054345 PMCID: PMC8775174 DOI: 10.3390/diagnostics12010174] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Flexible bronchoscopy plays a critical role in both diagnostic and therapeutic management of a variety of pulmonary disorders in the bronchoscopy suite and the intensive care unit. In the set-ting of the ongoing viral pandemic, single-use flexible bronchoscopes (SUFB) have garnered attention as various professional pulmonary societies have released guidelines regarding uses for SUFB given the concern for risk of viral transmission when using reusable flexible bronchoscopes (RFB). In addition to offering sterility, SUFBs are portable, easily accessible, and may be more cost-effective than RFB when considering the potential costs of treating bronchoscopy-related infections. Furthermore, since SUFBs are one time use, they do not require reprocessing after use, and therefore may translate to reduced cleaning and storage costs. Despite these advantages, RFBs are still routinely used to perform advanced diagnostic and therapeutic bronchoscopic procedures given the need for optimal maneuverability, handling, angle of deflection, image quality, and larger channel size for passing of ancillary instruments. Here, we review the published evidence on the applications of single-use and reusable bronchoscopes in bronchoscopy suites and intensive care units. Specifically, we will discuss the advantages and disadvantages of these devices as pertinent to fundamental, advanced, and therapeutic bronchoscopic interventions.
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Affiliation(s)
- Elliot Ho
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Ajay Wagh
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
| | - Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
| | - Septimiu Murgu
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
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Godoy MCB, Truong MT, Jimenez CA, Shroff GS, Vlahos I, Casal RF. Imaging of therapeutic airway interventions in thoracic oncology. Clin Radiol 2021; 77:58-72. [PMID: 34736758 DOI: 10.1016/j.crad.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
Abstract
Tracheobronchial obstruction, haemoptysis, and airway fistulas caused by airway involvement by primary or metastatic malignancies may result in dyspnoea, wheezing, stridor, hypoxaemia, and obstructive atelectasis or pneumonia, and can lead to life-threatening respiratory failure if untreated. Complex minimally invasive endobronchial interventions are being used increasingly to treat cancer patients with tracheobronchial conditions with curative or, most often, palliative intent, to improve symptoms and quality of life. The selection of the appropriate treatment strategy depends on multiple factors, including tumour characteristics, whether the lesion is predominately endobronchial, shows extrinsic compression, or a combination of both, the patient's clinical status, the urgency of the clinical scenario, physician expertise, and availability of tools. Pre-procedure multidetector computed tomography (MDCT) imaging can aid in the most appropriate selection of bronchoscopic treatment. Follow-up imaging is invaluable for the early recognition and management of any potential complication. This article reviews the most commonly used endobronchial procedures in the oncological setting and illustrates the role of MDCT in planning, assisting, and follow-up of endobronchial therapeutic procedures.
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Affiliation(s)
- M C B Godoy
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - M T Truong
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - C A Jimenez
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - G S Shroff
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - I Vlahos
- Department of Thoracic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - R F Casal
- Department of Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Kalsi HS, Thakrar R, Gosling AF, Shaefi S, Navani N. Interventional Pulmonology: A Brave New World. Thorac Surg Clin 2020; 30:321-338. [PMID: 32593365 DOI: 10.1016/j.thorsurg.2020.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Interventional pulmonology is a dynamic and evolving field in respiratory medicine. Advances have improved the ability to diagnose and manage diseases of the airways. A shift toward early detection of malignant disease has generated a focus on innovative diagnostic techniques. With patient populations living longer with malignant and benign diseases, the role for interventional bronchoscopy has grown. In cancer groups, novel immunotherapies have improved the prospects of clinical outcomes and reignited a focus on optimizing patient performance status to enable access to anticancer therapy. This review discusses current and emerging diagnostic modalities and therapeutic approaches available to manage airway diseases.
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Affiliation(s)
- Hardeep S Kalsi
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Ricky Thakrar
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK
| | - Andre F Gosling
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, MA, USA
| | - Neal Navani
- Division of Medicine, Lungs for Living Research Centre, UCL Respiratory, University College London, Rayne Building, 5 University Street, London, UK.
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Rosell A, Stratakos G. Therapeutic bronchoscopy for central airway diseases. Eur Respir Rev 2020; 29:29/158/190178. [PMID: 33208484 DOI: 10.1183/16000617.0178-2019] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/27/2020] [Indexed: 12/29/2022] Open
Abstract
Over the past century rigid bronchoscopy has been established as the main therapeutic means for central airway diseases of both benign and malignant aetiology. Its use requires general anaesthesia and mechanical ventilation usually in the form of manual or high-frequency jet ventilation. Techniques applied to regain patency of the central airways include mechanical debulking, thermal ablation (laser, electrocautery and argon plasma coagulation) and cryo-surgery. Each of these techniques have their advantages and limitations and best results can be attained by combining different modalities according to the type, location and extent of the airway blockage. If needed, deployment of airway endoprostheses (stents), as either fixed-diameter silicone or self-expandable metal stents, may preserve the airways patency often at the cost of several complications. Newer generation of customised stents either three-dimensional printed or drug-eluting stents constitute a promise for improved safety and efficacy results in the near future. Treating central disease of benign or malignant aetiology, foreign body aspiration or massive bleeding in the airways requires a structured approach with combined techniques, a dedicated team of professionals and experience to treat eventual complications. Specific training and fellowships in interventional pulmonology should therefore be offered to those who wish to specialise in this field.
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Affiliation(s)
- Antoni Rosell
- Universitat Autònoma de Barcelona, Thorax Institute, Hospital Universitari Germans Trias, Badalon, Spain
| | - Grigoris Stratakos
- National and Kapodistrian University of Athens, Interventional Pulmonology Unit, "Sotiria" Hospital, Athens, Greece
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Dutau H, Di Palma F, Thibout Y, Febvre M, Cellerin L, Naudin F, Hermant C, Vallerand H, Lachkar S, Fournier C, Laroumagne S, Quiot JJ, Vergnon JM. Impact of Silicone Stent Placement in Symptomatic Airway Obstruction due to Non-Small Cell Lung Cancer – A French Multicenter Randomized Controlled Study: The SPOC Trial. Respiration 2020; 99:344-352. [DOI: 10.1159/000506601] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/16/2020] [Indexed: 11/19/2022] Open
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Mahajan AK, Ibrahim O, Perez R, Oberg CL, Majid A, Folch E. Electrosurgical and Laser Therapy Tools for the Treatment of Malignant Central Airway Obstructions. Chest 2019; 157:446-453. [PMID: 31472155 DOI: 10.1016/j.chest.2019.08.1919] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 07/13/2019] [Accepted: 08/11/2019] [Indexed: 01/25/2023] Open
Abstract
Central airway obstruction (CAO) is associated with significant morbidity and increased mortality. Bronchoscopic electrosurgical and laser ablative tools have proven to be safe and effective instruments for the treatment of malignant CAO. Although therapeutic modalities such as electrocautery, argon plasma coagulation, and laser have been used for decades, additional tools including radiofrequency ablation catheters continue to be developed for the treatment of CAO. These modalities are considered safe in the hands of experienced operators, although serious complications can occur. This review describes various electrosurgical and laser therapy tools used for the treatment of malignant CAO along with the specific advantages and disadvantages of each device.
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Affiliation(s)
- Amit K Mahajan
- Interventional Pulmonology and Complex Airways Disease Program, Division of Thoracic Surgery and Interventional Pulmonology, Inova Fairfax Medical Center, Falls Church, VA.
| | - Omar Ibrahim
- Division of Pulmonary and Critical Care Medicine, University of Connecticut Medical School, Hartford, CT
| | - Ricardo Perez
- Division of Pulmonary and Critical Care Medicine, University of Connecticut Medical School, Hartford, CT
| | - Catherine L Oberg
- Division of Pulmonary, Critical Care Medicine, Clinical Immunology, and Allergy, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Erik Folch
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Shepherd RW, Radchenko C. Bronchoscopic ablation techniques in the management of lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:362. [PMID: 31516908 DOI: 10.21037/atm.2019.04.47] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Central airway involvement is a common manifestation of lung cancer during the disease course. Some patients will require bronchoscopic therapeutic interventions to palliate symptoms, or less commonly to provide more definitive therapy of airway involvement. We describe an overview specifically of bronchoscopic ablative techniques that are available for use in malignant airway obstruction. Techniques that are more commonly used include bronchoscopic application of laser, electrocautery, argon plasma coagulation (APC), cryotherapy and mechanical debulking techniques. Less commonly employed are brachytherapy and photodynamic therapy. These techniques may be applied via flexible or rigid bronchoscopy depending upon the clinical scenario. The choice of technique depends on available tools and expertise, the urgency of the clinical scenario, and whether the lesion is predominately endobronchial, extrinsic compression, or a combination of both. Malignant airway obstruction is a common finding in lung cancer and there are a number of effective bronchoscopic ablative techniques that may be employed safely to palliate patients with a significant symptom burden.
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Affiliation(s)
- Ray W Shepherd
- Division of Pulmonary and Critical Care, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Christopher Radchenko
- Division of Pulmonary and Critical Care, University of Cincinnati Health System, Cincinnati, OH, USA
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13
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Ittrich H, Bockhorn M, Klose H, Simon M. The Diagnosis and Treatment of Hemoptysis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018. [PMID: 28625277 DOI: 10.3238/arztebl.2017.0371] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hemoptysis, i.e., the expectoration of blood from the lower airways, has an annual incidence of approximately 0.1% in ambulatory patients and 0.2% in inpatients. It is a potentially life-threatening medical emergency and carries a high mortality. METHODS This review article is based on pertinent publications retrieved by a selective search in PubMed. RESULTS Hemoptysis can be a sign of many different diseases. Its cause remains unknown in about half of all cases. Its more common recognized causes include infectious and inflammatory airway diseases (25.8%) and cancer (17.4%). Mild hemoptysis is self-limited in 90% of cases; massive hemoptysis carries a worse prognosis. In patients whose life is threatened by massive hemoptysis, adequate oxygenation must be achieved through the administration of oxygen, positioning of the patient with the bleeding side down (if known), and temporary intubation if necessary. A thorough diagnostic evaluation is needed to identify the underlying pathology, site of bleeding, and vascular anatomy, so that the appropriate treatment can be planned. The evaluation should include conventional chest x-rays in two planes, contrastenhanced multislice computerized tomography, and bronchoscopy. Hemostasis can be achieved at bronchoscopically accessible bleeding sites with interventionalbronchoscopic local treatment. Bronchial artery embolization is the first line of treatment for hemorrhage from the pulmonary periphery; it is performed to treat massive or recurrent hemoptysis or as a presurgical measure and provides successful hemostasis in 75-98% of cases. Surgery is indicated if bronchial artery embolization alone is not successful, or for special indications (traumatic or iatrogenic pulmonary/vascular injury, refractory asper gilloma). CONCLUSION The successful treatment of hemoptysis requires thorough diagnostic evaluation and close interdisciplinary collaboration among pulmonologists, radiologists, and thoracic surgeons.
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Affiliation(s)
- Harald Ittrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg; Department of General, Visceral and Thoracic Surgery, Center for Surgical Sciences, University Medical Center Hamburg-Eppendorf, Hamburg; Department of Pulmonology, II. Medical Clinic, University Medical Center Hamburg-Eppendorf, Hamburg
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Sharma PV, Jobanputra YB, Perdomo Miquel T, Schroeder JR, Wellikoff A. Primary intratracheal schwannoma resected during bronchoscopy using argon plasma coagulation. BMJ Case Rep 2018; 2018:bcr-2018-225140. [PMID: 30232068 DOI: 10.1136/bcr-2018-225140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 63-year-old man presented with intermittent, progressively worsening dyspnoea associated with cough and blood-tinged sputum. Initial work-up showed left axis deviation on ECG, chest X-ray with an elevated left hemidiaphragm and a non-contrast CT chest that showed a multilobulated mass in the proximal trachea. Bronchoscopy showed a whitish-appearing lesion, which was then sampled and partially resected with pathology showing a schwannoma with no malignant cells. He felt partial relief post procedure; however, he presented a month later with similar symptoms of dyspnoea and a repeat CT scan showed enlargement of the mass in the same location. The patient underwent another flexible bronchoscopy and resection with argon plasma coagulation (APC)/electrocautery snare. APC/electrocautery is an effective interventional bronchoscopy technique that can be used to resect endoluminal lesions or extraluminal lesions that have infiltrated into the airway using flexible/rigid bronchoscopy. It is more cost-effective, safe, works well with vascular lesions and achieves excellent haemostasis as compared with Nd:YAG lasers.
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Affiliation(s)
- Purva V Sharma
- Department of Internal Medicine, University of Miami School of Medicine, Atlantis, Florida, USA
| | - Yash B Jobanputra
- Department of Internal Medicine, University of Miami School of Medicine, Atlantis, Florida, USA
| | | | - J Ryan Schroeder
- Department of Interventional Pulmonology, JFK Medical Center, Atlantis, Florida, USA
| | - Adam Wellikoff
- Department of Interventional Pulmonology, JFK Medical Center, Atlantis, Florida, USA
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15
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Flannery A, Daneshvar C, Dutau H, Breen D. The Art of Rigid Bronchoscopy and Airway Stenting. Clin Chest Med 2018; 39:149-167. [DOI: 10.1016/j.ccm.2017.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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16
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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: 1.1] [Reference Citation Analysis] [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
This review comprehensively describes recent advances in the management of malignant central airway obstruction (CAO). Malignant CAO can be a dramatic and devastating manifestation of primary lung cancer or metastatic disease. A variety of diagnostic modalities are available to provide valuable information to plan a therapeutic intervention. Clinical heterogeneity in the presentation of malignant CAO provides opportunities to adapt and utilize endoscopic technology and tools in many ways. Mechanical debulking, thermal tools, cryotherapy and airway stents are methods and instruments used to rapidly restore airway patency. Delayed bronchoscopic methods, such as photodynamic therapy (PDT) and brachytherapy can also be utilized in specific non-emergent situations to establish airway patency. Although data regarding the success and complications of therapeutic interventions are retrospective and characterized by clinical and outcome measure variability, the symptoms of malignant CAO can often be successfully palliated. Assessment of risks and benefits of interventions in each individual patient during the decision-making process forms the critical foundation of the management of malignant CAO.
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Affiliation(s)
- Lakshmi Mudambi
- Division of Pulmonary, VA Portland Health Care System, Oregon Health & Science University, Portland, OR, USA
| | - Russell Miller
- Division of Pulmonary, Interventional Pulmonology, Naval Medical Center, San Diego, CA, USA
| | - George A Eapen
- Division of Interventional Pulmonology, University of Texas-MD Anderson Cancer Center, Houston, TX, USA
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18
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Ma C, Xu X, Zhang R, Qin S, Zhou J. Computed tomography-guided intraluminal brachytherapy in recurrent bronchogenic carcinoma: A clinical trial in a small group. PRECISION RADIATION ONCOLOGY 2017. [DOI: 10.1002/pro6.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Chenying Ma
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
| | - Xiaoting Xu
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
| | - Ruting Zhang
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
| | - Songbing Qin
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
| | - Juying Zhou
- Department of Radiotherapy; First Affiliated Hospital of Soochow University; Suzhou China
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19
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Elkolaly RM, Korraa EEDA, Ibrahim ISE. Electrocautery and cryotherapy in inoperable malignant lung lesions. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_23_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Kanchustambham V, Saladi S, Mehta K, Mwangi J, Jamkhana Z, Patolia S. Vascular Air Embolism During Bronchoscopy Procedures- Incidence, Pathophysiology, Diagnosis, Management and Outcomes. Cureus 2017; 9:e1087. [PMID: 28405537 PMCID: PMC5384844 DOI: 10.7759/cureus.1087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/09/2017] [Indexed: 12/19/2022] Open
Abstract
Vascular air embolism (VAE) is a rare, but potentially fatal complication of invasive medical or surgical procedures. It is a very rare complication of bronchoscopy and is most frequently reported with therapeutic bronchoscopy with Argon plasma coagulation (APC) or neodymium-doped yttrium aluminum garnet (Nd-YAG) laser. Despite being rare, as a result of its high chance of mortality and morbidity, it is imperative that physicians have high clinical suspicion to allow for early recognition and treatment. In this article, we provide a concise review of the incidence, pathophysiology, diagnosis management and outcomes of air embolism during bronchoscopy procedures.
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Affiliation(s)
| | - Swetha Saladi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine
| | - Kris Mehta
- Internal Medicine, Saint Louis University School of Medicine
| | - John Mwangi
- Pulmonary and Critical Care Medicine , Saint Louis University School of Medicine
| | - Zafar Jamkhana
- Pulmonary and Critical Care Medicine , Saint Louis University School of Medicine
| | - Setu Patolia
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine
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21
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Goudie E, Tahiri M, Liberman M. Present and Future Application of Energy Devices in Thoracic Surgery. Thorac Surg Clin 2016; 26:229-36. [PMID: 27112261 DOI: 10.1016/j.thorsurg.2015.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In the last decade, many energy devices have entered day-to-day practice in thoracic surgery. Some have proven and recognized applications, whereas others still require further trials. Nevertheless, currently used devices continue to be improved on and new applications for current devices will be evaluated. Ultimately, novel applications of energy in thoracic surgery and refinement in technology will hopefully allow for safer and less invasive techniques for patients requiring thoracic surgical procedures. In this article, we review the present and future applications of energy devices in thoracic surgery.
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Affiliation(s)
- Eric Goudie
- Thoracic Surgery Laboratory, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de l'Université de Montréal, University of Montreal, 1560 Sherbrooke Street Est, 8e CD - Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1, Canada
| | - Mehdi Tahiri
- Thoracic Surgery Laboratory, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke Street Est, 8e CD - Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center (CETOC), Centre Hospitalier de l'Université de Montréal, University of Montreal, 1560 Sherbrooke Street Est, 8e CD - Pavillon Lachapelle, Suite D-8051, Montreal, Quebec H2L 4M1, Canada.
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22
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Azok JT, Bolen MA, Lempel JK, Renapurkar RD. Spectrum of Imaging Findings Following Bronchoscopic Intervention. Curr Probl Diagn Radiol 2015; 46:35-46. [PMID: 26692210 DOI: 10.1067/j.cpradiol.2015.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/30/2015] [Indexed: 11/22/2022]
Abstract
Interventional pulmonology (IP) is a relatively new field that uses endoscopy and other technologies for both the diagnosis and treatment of pulmonary and thoracic conditions. IP is a continually developing field driven by clinical need as well as technological and therapeutic innovation. Developments in IP have increased both the efficacy and breadth of procedures that may be encountered by radiologists on periprocedural and postprocedural imaging. In this article, we will describe commonly performed IP procedures, with a focus on relevant imaging implications for radiologists.
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Affiliation(s)
- Joseph T Azok
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH.
| | - Michael A Bolen
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH; Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Jason K Lempel
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Rahul D Renapurkar
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
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23
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Usefulness of Rigid Bronchoscopic Intervention Using Argon Plasma Coagulation for Central Airway Tumors. Clin Exp Otorhinolaryngol 2015; 8:396-401. [PMID: 26622961 PMCID: PMC4661258 DOI: 10.3342/ceo.2015.8.4.396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/17/2014] [Accepted: 08/08/2014] [Indexed: 12/05/2022] Open
Abstract
Objectives Argon plasma coagulation (APC) is a noncontact form of electrocautery that utilizes ionized argon as the electrical current. A rigid bronchoscopic use of APC for the management of central airway obstruction could be safe and rapidly effective. This study evaluated the usefulness of rigid bronchoscopy with APC for the management of central airway obstructions due to benign or malignant tumors. Methods Twenty patients with obstructing central airway tumors were retrospectively reviewed from February 2008 to February 2013 at Chonnam National University Hospital. All patients received rigid bronchoscopic tumor removal under general anesthesia. APC was applied before and after tumor removal. Results The median age of patients was 59 years (interquartile range [IQR], 51 to 67 years) and 70% were female. The causes of airway obstruction included malignancy (n=8) and benign tumor (n=12). Airway tumors comprised intraluminal lesions (n=11, 55%) and mixed intraluminal/extraluminal lesions (n=9, 45%). The median tumor size was 15 mm (IQR, 10 to 18 mm). The median degree of airway obstruction was significantly reduced after intervention (90% [IQR, 88% to 96%] vs. 10% [IQR, 0% to 20%], P<0.001). The median American Thoracic Society dyspnea grade (3 [IQR, 1 to 4] vs. 1 [IQR, 0 to 1], P<0.001) and forced expiratory volume in one second (1.03 L [IQR, 0.52 to 1.36 L] vs. 1.98 L [IQR, 1.57 to 2.64 L], P=0.004) were significantly improved after intervention. There were no procedure-related acute complications and deaths. Conclusion Rigid bronchoscopy with APC is an effective and safe procedure to alleviate central airway obstruction caused by tumors.
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24
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Mitchell PD, Kennedy MP. Bronchoscopic management of malignant airway obstruction. Adv Ther 2014; 31:512-38. [PMID: 24849167 DOI: 10.1007/s12325-014-0122-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Indexed: 12/17/2022]
Abstract
Approximately one-third of patients with lung cancer will develop airway obstruction and many cancers lead to airway obstruction through meta stases. The treatment of malignant airway obstruction is often a multimodality approach and is usually performed for palliation of symptoms in advanced lung cancer. Removal of airway obstruction is associated with improvement in symptoms, quality of life, and lung function. Patient selection should exclude patients with short life expectancy, limited symptoms, and an inability to visualize beyond the obstruction. This review outlines both the immediate and delayed bronchoscopic effect options for the removal of airway obstruction and preservation of airway patency with endobronchial stenting.
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Affiliation(s)
- Patrick D Mitchell
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Republic of Ireland
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25
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Lazarus DR, Eapen GA. Bronchoscopic Interventions for Lung Cancer. Lung Cancer 2014. [DOI: 10.1002/9781118468791.ch16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Hussein RM, Korraa EEDA, Amany Fawzy M, Sileem AE. Prognostic factors for bronchoscopic electrocautery and/or argon plasma coagulation in patients with central airway obstruction. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kajiwara N, Kakihana M, Usuda J, Ohira T, Kawate N, Ikeda N. Interventional management for benign airway tumors in relation to location, size, character and morphology. J Thorac Dis 2012; 3:221-30. [PMID: 22263096 DOI: 10.3978/j.issn.2072-1439.2011.04.06] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Accepted: 03/25/2011] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To select minimally stressful methods for patients with benign bronchial tumors, and evaluate interventional strategies in relation to location, size, character and morphology. METHODS We reviewed the indications and efficacy of various interventional bronchology techniques at our institution, including individual or combined laser resection, electrocautery, argon plasma coagulation and high radiofrequency snaring for the treatment of various types of benign bronchial tumors. RESULTS It is essential to treat endoscopically that the tumor is visible and has a stalk and not invade beyond bronchial wall. By using combined techniques, no complications or recurrences were encountered. CONCLUSIONS Interventional bronchology techniques for benign bronchial tumors can be simple and safe, and therapeutic strategies should be designed in relation to location, size, character and morphology of tumors.
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28
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Li Y, Feng H, Nie Z, Meng J, Ding X, Han Z. Cryorecanalization after cryosurgery for immediate treatment on central airway obstruction via flexible bronchoscope. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s10330-012-1025-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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29
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Cryorecanalization: keys to success. Surg Endosc 2012; 26:2969-74. [DOI: 10.1007/s00464-012-2260-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 03/16/2012] [Indexed: 12/17/2022]
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30
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Hetzel J, Kumpf M, Hetzel M, Hofbeck M, Baden W. Cryorecanalization of an obstructed bronchial stent in a 12-year-old boy. ACTA ACUST UNITED AC 2011; 82:290-3. [PMID: 21212642 DOI: 10.1159/000322556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 11/03/2010] [Indexed: 11/19/2022]
Abstract
We report a 12-year-old boy who underwent stent implantation into the left main bronchus at the age of 9.5 years for palliation of severe bronchial stenosis. He had developed complete obstruction of the stent by granulation tissue resulting in respiratory deterioration and the requirement of mechanical ventilation. The stent obstruction was treated at the age of 11.5 years by cryorecanalization. In this technique, cooling of the tip of the cryoprobe is used to induce adherence of the obstructing tissue allowing the subsequent removal of tissue particles by retraction of the probe. Under general anesthesia, a miniaturized cryoprobe was advanced via the working channel of a flexible bronchoscope. Repeat maneuvers of freezing and retraction resulted in complete recanalization of the stent. Repeat bronchoscopies 4 and 12 weeks later revealed recurrent formation of some granulation tissue which was removed by repeat cryorecanalization. Seven months after the initial procedure there was a complete patency of the stent. According to our experience, cryorecanalization is a safe and effective alternative for the treatment of stent obstruction by granulation tissue. Due to the introduction of a miniaturized probe, this method is well applicable in children since it can be performed via the working channel of a flexible pediatric bronchoscope.
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Affiliation(s)
- J Hetzel
- Internal Medicine, Children's Hospital, University of Tübingen, Germany
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31
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Bandyopadhyay D, Induru RR. Role of palliative tracheobronchial stenting in hospice patients: boon or bane? Am J Hosp Palliat Care 2010; 28:445-8. [PMID: 21187290 DOI: 10.1177/1049909110393722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lung cancer is the leading cause of cancer mortality and morbidity. Patients with advanced lung cancer have distressful symptoms like dyspnea. It has severe negative impact on the quality of life. Airway stenting has become widespread for palliation of airway stenosis in patients with metastatic airways disease. Although it provides improvement in symptoms, actual survival benefit is limited with severe potential complications. Appropriate patient selection in terms of site of tumor, type of stent placement is needed to achieve maximum benefit for patients. Here we will discuss 2 patients with advanced lung cancer who received bronchial stent for intractable dyspnea. Although there was dramatic improvement in symptoms and quality of life, both died shortly. Was there any benefit of stenting remained unanswered.
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32
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Amat B. Tecnificación de los gabinetes de endoscopia respiratoria. Arch Bronconeumol 2010; 46:285-7. [DOI: 10.1016/j.arbres.2010.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 02/21/2010] [Accepted: 02/23/2010] [Indexed: 12/20/2022]
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33
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Schumann C, Hetzel M, Babiak AJ, Hetzel J, Merk T, Wibmer T, Lepper PM, Krüger S. Endobronchial tumor debulking with a flexible cryoprobe for immediate treatment of malignant stenosis. J Thorac Cardiovasc Surg 2010; 139:997-1000. [DOI: 10.1016/j.jtcvs.2009.06.023] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 05/09/2009] [Accepted: 06/20/2009] [Indexed: 11/16/2022]
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34
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35
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Freitag L, Macha HN. [Hemoptysis]. Internist (Berl) 2004; 45:555-64. [PMID: 15054577 DOI: 10.1007/s00108-004-1173-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hemoptysis is a potentially life-threatening complication of various diseases. The most common causes are infectious and inflammatory processes, followed by neoplasms, pulmonary embolisms, mitral stenoses, coagulopathies, and multiple systemic disorders. Primary examinations include a chest x-ray, an angio CT and a bronchoscopy. Sometimes, a bronchial artery angiogram is required. The patient is at risk of suffocation because blood and clots can severely obstruct his airways. Thus, the most important measures are: supplemental oxygen, positioning the patient with the bleeding side down, bronchoscopical suctioning and removal of blood and clots. Coagulopathies have to be corrected. Application of vasoactive drugs may help temporarily. In cases of bleeding from central lesions, coagulation with laser or argon-plasma-coagulator is feasible. Heavy bleeding from the periphery requires a balloon or tube tamponade. Depending on the cause and the severity of the bleeding either anti-inflammatory medical treatment, hemostyptic radiation therapy, bronchial artery embolisation or a surgical procedure must follow.
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36
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Schubert D, Kuhn R, Lippert H, Pross M. Endoscopic treatment of benign gastrointestinal anastomotic strictures using argon plasma coagulation in combination with diathermy. Surg Endosc 2003; 17:1579-82. [PMID: 12874683 DOI: 10.1007/s00464-002-9173-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2002] [Accepted: 03/18/2003] [Indexed: 12/18/2022]
Abstract
BACKGROUND Initially, treatment for anastomotic strictures was surgical. Currently. however, endoscopic techniques are preferred. This study aimed to investigate the efficiency and safety of endoscopic treatment using argon plasma coagulation in combination with diathermy. METHODS From 1995 to 2000, 49 patients with postsurgical anastomotic strictures of the esophagus or colon were referred for endoscopic treatment. In all cases, radiologic and endoscopic examination showed membranous or short strictures (diameter, 3-8 mm). Under direct endoscopic control, the scar tissue at the anastomotic line was incised radially with a polypectomy snare. The scar tissue between the incisions then was reduced carefully by argon plasma coagulation. RESULTS All 49 patients were treated successfully with this combined endoscopic technique. Only for four patients was more than one endoscopic session (mean, 3.5; range, 2-6) needed to guarantee long-term success. No complications were encountered. CONCLUSIONS Endoscopic argon plasma coagulation in combination with diathermy is a safe and effective technique for the treatment of short postsurgical gastrointestinal anastomotic strictures.
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Affiliation(s)
- D Schubert
- Department of General, Visceral and Vascular Surgery, Faculty of Medicine, Otto von Guericke University Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany.
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37
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Capaccio P, Peri A, Fociani P, Ferri A, Ottaviani F. Flexible argon plasma coagulation treatment of obstructive tracheal metastatic melanoma. Am J Otolaryngol 2002; 23:253-5. [PMID: 12105794 DOI: 10.1053/ajot.2002.123455] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Metastases to the tracheobronchial tree may be considered rare, and melanoma metastases to the trachea are very uncommon. We here report the case of a 61-year-old woman with metastatic melanoma to the trachea occurring 2 years after the excision of a right shoulder skin nodule. The patient underwent argon plasma coagulation (APC) recanalization of the malignant airway under flexible bronchoscopy, which led to the stable resolution of the respiratory symptoms. We also discuss the possible palliative therapeutic options for such metastases, including the APC technique.
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Affiliation(s)
- Pasquale Capaccio
- IV Clinica Otorinolaringoiatrica - Università degli Studi di Milano, Polo Universitario, Ospedale L. Sacco, Milan, Italy
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