SESSION TITLE: Pleural Disease
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 02:45 PM - 04:15 PM
PURPOSE: The aim of this study is to analyze safety, feasibility, and outcomes of Medical thoracoscopy, when performed by Interventional Pulmonologist in a major academic medical center.
METHODS: We performed a retrospective review of 100 consecutive patients who underwent MT for diagnostic and/or therapeutic purposes. Demographic,procedural,histological and radiographic data were collected and subsequently analyzed to determine diagnostic yield, success of pleurodesis and complications. We defined a diagnostic biopsy as either having a specific tissue diagnosis (cancer or non-caseiting granulomas) or those who had a diagnosis of nonspecific pleuritis who were followed for 12 months without evidence of disease progression. Successful pleurodesis was defined as > 90% lung re-expansion at follow up.
RESULTS: There were 59 male patients with an average age of 68 years (range 37-93), and ECOG score was 0 (15%), 1 (61%) and 2 (24%). Most common presenting symptoms were short of breath (76%), cough (28%) and chest pain(15%). Patients' co-morbidities included COPD (13%), CRF (14%), CHF (9%) and cancer (76%). The indication for procedure was diagnostic (83%), therapeutic (77%) or both (66%). Most common histological diagnosis were cancer (61%) and non-specific pleuritis (39%). Mean volume of pleural fluid drained was 1279.8 L Mean duration of procedure was 118.76 minutes. 69% of the procedures were performed in the right side. Associated procedures included: pleural biopsy (83%) talc pleurodesis (77%) (Talc: 5.27g on average), and insertion of tunnelled pleural catheter (95%). Mean length of hospitalization was 5.71 days (median 5). Of those undergoing talc poudrage, 95 % had successful pleurodesis. Diagnostic yield was 95%. Intraoperative complications included hypotention (2%),hypoxemia (2%) and moderate bleeding (1%) The most common immediate post-operative (<48h) complication was pain (19%). There were no late post-operative complication (>48h-30 days).
CONCLUSIONS: Medical thoracoscopy is a safe and effective procedure for the diagnosis of unclear exudates and management of recurrent pleural effusions when performed by experienced operators.
CLINICAL IMPLICATIONS: This experience shows the importance of Medical Thoracoscopy and aims to reccomend it, because of its safety, efficacy, diagnostic yield for unclear exudates, and possibility to manage recurrent pleural effusions.
DISCLOSURE: The following authors have nothing to disclose: Elisa Roca, Erik Folch, Meghan Fashjian, Adnan Majid
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