PURPOSE: Cryo-recanalization (CR) is a modification of endobronchial cryotherapy used to achieve rapid tracheobronchial patency in patients with central airway obstruction (CAO), for which data have thus far been reported from a single multi-institution group [Hetzel M et al. J Thorac Cardiovasc Surg 2004;127:1427-31]. This abstract reports initial experience with this technique from a UK centre.
METHODS: Data from consecutive bronchoscopic procedures for CAO were entered prospectively into a database, including demographics, diagnoses and procedure-related variables. These data were analysed retrospectively and all CR procedures included. All procedures were performed with flexible bronchoscopy (FB) using an Erbe CR probe (Erbokryo, Tubingen, Germany).
RESULTS: 56 CR procedures were performed in 44 patients (32 male, median age 67.5, range 24-84 years). The underlying diagnosis was primary lung malignancy in 33 patients, endobronchial metastasis in 9 and benign causes in 2. The trachea was involved in 3 patients, the right main bronchus (RMB) in 11 and the left main bronchus (LMB) in 24. 55/56 procedures used moderate sedation, with 1 performed under general anaesthetic. Median procedure time was 23 minutes (range 7-58 min). 4 cases were performed on inpatients (7.1%) and all others were treated as day-cases. Mean FEV1 improved from 1.61L (0.4L-3.3L) prior to procedure to 1.91L (0.85L-3.5L) after (p=0.0007, paired t test). There was immediate symptomatic improvement after 42/56 procedures (75%). CR was combined with other endobronchial treatments in 24 cases (stent insertion n=5, electrocautery 17, APC 11). There was 1 death < 30 days (1.8%), of progressive brain metastasis on day 20. Significant bleeding occurred after CR in 1 patient, which settled after endobronchial application of epinephrine and argon plasma coagulation (APC). No patient required an increase in level of care post-procedure.
CONCLUSION: CR, performed using FB on a day-case basis appears effective in improving symptoms and lung function in CAO. 30-day mortality appears acceptable.
CLINICAL IMPLICATIONS: Being effective, relatively safe, simple to employ and relatively inexpensive, CR may deserve more widespread use in interventional bronchoscopy.
DISCLOSURE: Mark Slade, University grant monies None; Grant monies (from sources other than industry) None; Grant monies (from industry related sources) None; Shareholder I have no shareholdings in any company; Employee I am not an employee of any company or organisation other than Papworth Hospital NHS Foundation Trust; Fiduciary position (of any organization, association, society, etc, other than ACCP Nothing to declare; Consultant fee, speaker bureau, advisory committee, etc. No fees received; Other My hospital, Papworth Hospital NHS Foundation Trust, is a reference centre for Olympus UK. Papworth Hospital benefits from the free loan of endobronchial and endoscopic ultrasound equipment valued at approximately £200,000 (approximately $300,000) from Olympus UK. Erbe Medical UK Ltd has made a contribution of £500 as part-sponsor of a course on interventional bronchoscopy which I organise annually at Papworth Hospital.; No Product/Research Disclosure Information