Pulmonary Procedures |

Cryodebridement for Airway Obstruction: A Retrospective Outcome and Safety Analysis FREE TO VIEW

Hanine Inaty, MD; Erik Folch, MD; Sebastian Fernandez-Bussy, MD; Robert Berger, MD; Adnan Majid, MD
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Chest Disease Center, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Chest. 2013;144(4_MeetingAbstracts):809A. doi:10.1378/chest.1703593
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SESSION TITLE: Bronchoscopy and Interventional Procedures Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Cryodebridement is a bronchoscopic technique that uses a cooling agent and a cryoprobe for tissue extraction and destruction. Although it has been used for immediate recanalization of large airways, experience is still limited. The aim of this study is to describe a single center experience, clinical outcomes and safety profile.

METHODS: Retrospective review of patients who underwent bronchoscopic cryodebridement for airway obstruction between December 2007 and March 2012.

RESULTS: One hundred and thirteen cases were identified. The most frequent diagnosis was malignant central airway obstruction (65) due to NCSLC and renal cell carcinoma. Among the non-malignant causes (48) removal of granulation tissue (32) was the most common indication followed by extraction of foreign bodies (5). The obstruction was at the level of the central airways in 70% of patients, lobar bronchi in 34% and segmental bronchi in 19%. Patients presented with dyspnea (42%), cough (18%) and hemoptysis (17%). Post-intervention, symptoms improved in 93% of the patients while 7% worsened. Airway patency was > 80% in 84 patients, 50-79% in 7 and < 50% in 22. Airway obstruction secondary to a foreign body, blood clot or mucus plug had 100% success rate. Concomitant techniques used included: balloon dilatation (22), mechanical debridement (58), electrosurgery (37) and stents (11). Median procedure length was 57 minutes (Mean 64 SD +/- 33). Complications were seen in 14 patients and included bleeding (6), bronchospasm (2) and respiratory failure (5). Bleeding was controlled with APC, electrocautery, iced saline, epinephrine or a combination. No deaths were reported within 30 days.

CONCLUSIONS: Cryodebridement when used alone or in combination with other endoscopic modalities has been shown to be safe and effective in treating endoluminal airway obstruction.

CLINICAL IMPLICATIONS: Cryodebridement is a safe, effective and inexpensive tool for the management of airway obstruction. It is particularly useful in patients with high oxygen requirements where thermal modalities may not be tolerated.

DISCLOSURE: The following authors have nothing to disclose: Hanine Inaty, Erik Folch, Sebastian Fernandez-Bussy, Robert Berger, Adnan Majid

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