PURPOSE: The optimum management of endobronchial lesions continues to evolve, with all current modalities having some limitations which render them valuable in some cases and unsuitable in others. Cryospray therapy, which was initially introduced for the management of esophageal disease, appears to be well suited for the management of endobronchial disease. This report describes our initial experience using cryospray therapy in the airway.
METHODS: A retrospective chart review was performed. 24 treatments were performed in 14 patients, 8 male and 6 female. Mean age was 65.7 years (range 51-87). The indication were: lung cancer(6); colorectal cancer (3); renal cell cancer (2); tracheobronchomalacia S/P stents (2); subglottic stenosis (1). Eight patients had stents placed at the time of cryospray therapy.
RESULTS: One patient has had 5 procedures performed for ongoing management of endobronchial granulation tissue following stenting for tracheobronchomalacia. One patient with colorectal cancer involving the airway has been treated on three separate occasions. 4 other patients with malignant disease of the airway have required 2 treatments. Complications were identified in four of 14 patients (28%). Three patients developed a pneumothorax requiring chest tube placement. Two of these patients had prior lung resections. All resolved without difficulty. The other complication was in the patient with subglottic stenosis who required a repeat bronchoscopy to remove eschar from the treatment site. This patient has not required any further interventions and the airway is widely patent.
CONCLUSION: Cryospray therapy presents another option for the management of endobronchial lesions. Compared to the laser, the risk of airway fires is eliminated. Unlike the GI tract, where a decompression tube can be placed, careful attention needs to placed on achieving adequate venting of the liquid nitrogen as it changes phases, otherwise the increased pressure can result in a pneumothorax. Stenting after cryospray has been very effective in those with malignant airway involvement.
CLINICAL IMPLICATIONS: Overall, cryospray therapy presents another useful modality in the management of endobronchial lesions. It is appropriate for both benign and malignant disease.
DISCLOSURE: Rudy Lackner, No Financial Disclosure Information; No Product/Research Disclosure Information