PURPOSE: Tracheobronchial superficial lesions are treated with Endobronchial procedures (Photodynamic Therapy; PDT, cryotherapy, or etc.). So we could not get the whole tissue of the tracheobronchial superficial lesion. Gastro-intestinal superficial lesions are lift up by injection to sub-epithelial layer and dissected by the electrocautery. We will report the pre-clinical experiment of Bronchoscopic Sub-epithelial Dissection (BSD) that lift up by injection to sub-epithelial layer and dissect tracheobronchial lesions by electrocautery, for getting the whole tissue of the lesion and complete cure.
METHODS: 1) Comparison of height and continuity of the pig tracheal epithelium injected by 3.7% NaCl, 50% glucose, glycerol, 0.4% Hyaluronic acid, 1% Hyaluronic acid, and Opegan-Hi. 2) BSD in canine under general anesthesia. 1.0% Hyaluronic acid or Opegan-Hi (0.4-0.8ml) was injected into the submucosal tissue via 25G needle through the working channel of the bronchoscope( BF-1T260, Olympus). Flex knife or Dual Knife was employed to dissect the injected submucosal layer. Histopathological findings of the resected specimen and the dissected tracheobronchial wall were compared. On histopathological findings, healing of dissected wall was evaluated.
RESULTS: 1) 5.6mm in the mean height with Opegan-Hi was highest and continued for 30 minutes. The protrusion by injection of 0.8% Hyaluronic acid, 1% Hyaluronic acid, and Opegan-Hi, was continued for 30 minutes. 2) In all thirteen procedures of BSD (trachea: 4, main bronchus: 1, lobar bronchus: 1, segmental bronchus: 7), ESD was successful. Followed up 10 lesions, epithelium covered the dissected surface in 2 weeks after BSD. There was one complication of bronchial stenosis after BSD.
CONCLUSION: 0.8%Hyaluronic acid, 1%Hyaluronic acid, and Opegan-Hi were suitable materials for BSD. BSD with 1%Hyaluronic acid and Opegan-Hi, was successful.
CLINICAL IMPLICATIONS: BSD may be feasible for getting the whole tissue of the superficial malignant lesion and complete cure.
DISCLOSURE: Noriaki Kurimoto, No Financial Disclosure Information; No Product/Research Disclosure Information