SESSION TITLE: Bronchology/Interventional Global Case Reports
SESSION TYPE: Global Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Bronchial ethanol injection therapy is a palliative therapy for air way stenosis caused by lung cancer. It is effective for endobronchial polypoid tumors but ineffective for extrawall tumors. There were no indication of effects resulting from ethanol injection or air way leakage of ethanol. We performed an initial study to examine the ability of endobronchial ultrasound-guided bronchial ethanol injection therapy (EBUS-BEIT) to reduce the blood flow and volume of an endobronchial tumor causing tracheal stenosis; percutaneous ethanol injection therapy (PEIT) was also performed for a liver cell tumor and a parathyroid tumor.
CASE PRESENTATION: A 56-year-old man was admitted to our hospital for treatment of tracheal stenosis due to recurring squamous cell carcinoma. We performed EBUS-BEIT prior to stent placement. While viewing the tumor in real time using EBUS, we injected 0.2 ml ethanol into the tumor. High echoic lesions appeared near the tip of the needle after injection of ethanol, and we were able to confirm lesions of coagulative necrosis. There were three patterns of high echoic lesion expanse in the tumor; however, we could not detect these patterns prior to ethanol injection. We repeated EBUS-BEIT until high echoic lesions were apparent in the entire tumor, and we confirmed blood flow reduction by Doppler echocardiography. There were few bleeding events that occurred when we performed tumor debulking followed by DUMON stent placement.
DISCUSSION: Because EBUS avoids normal mediastinum structures, we expect this therapy to be effective for extrawall tumors．The limitation of this therapy was that the region depicted using EBUS is very difficult to view by bronchoscopy.
CONCLUSIONS: We could confirm ethanol expanse in the tumor using EBUS-BEIT and blood flow reduction using Doppler echocardiography in real time. After EBUS-BEIT, there were few bleeding events that occurred during tumor debulking, and thus we could confirm the actual blood flow reduction effect using ethanol.
Reference #1: Fujisawa T, Hongo H, Tamaguchi Y, et al. Intratumoral ethanol injection for malignant tracheobronchial lesions: A new bronchofiberscopic procedure. Endoscopy 1986;18:188-191 Chan AL, Yoneda KY, Allen RP, et al. Advances in the management of endobronchial lung malignancies. Curr Opin Pilm Med 2003;9:301-308
Reference #2: Chan AL, Yoneda KY, Allen RP, et al. Advances in the managemant of endobronchial lung malignancies. Curr Opin Pilm Med 2003;9:301-308
DISCLOSURE: The following authors have nothing to disclose: Shinichi Iwamoto, Hibiki Kanda, Mitsuhiro Tada, Emiko Nishikawa, Toru Kadowaki, Masahiro Kimura, Kanako Kobayashi, Toshikazu Ikeda, Shuichi Yano
No Product/Research Disclosure Information