Pulmonary Procedures |

A Randomized Controlled Trial Assessing a Novel Encapsulated Cryoprobe for Flexible Bronchoscopic Sampling of Lung Parenchyma: First Report of an Animal Feasibility Trial FREE TO VIEW

Lonny Yarmus, DO; Sixto Arias, MD; David Feller-Kopman, MD; Roy Semaan, MD; Bernice Frimpong, BA; Ricardo Ortiz, BS; Karen Oakjones-Burgess, MS; Falco Fend, MD; Hans Boesmueller, MD; Hans Lee, MD
Author and Funding Information

The Johns Hopkins Hospital, Pikesville, MD

Chest. 2015;148(4_MeetingAbstracts):810A. doi:10.1378/chest.2270594
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SESSION TITLE: Interventional Pulmonology Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Transbronchial biopsies (TBBx) with forceps suffer from crush artifact. The cryoprobe (CBx) has signficantly improved size and preservation compared to forceps biopsy (FBx). A major technical difference is that FBx specimen retrieval is performed through the working channel allowing the bronchoscope to stay in place during the entire procedure. The CBx is advanced through the working channel but due to sample size, the cryoprobe and bronchoscope must be removed together. The ability to leave the scope in the airway is a major technical advantage of FBx over CBx for safety and procedural monitoring. We developed an encapsulated cryoprobe allowing the scope to remain in the airway to monitor for bleeding. We propose this device would combine the sample size advantage of CBx with the safety advantage of a removable probe.

METHODS: Three pigs were intubated after approval by the animal IRB at the Johns Hopkins Hospital. A flexible bronchoscope was used and TBBX in a randomized fashion with fluoroscopy was performed with a : A 2.0MM FBx, a 1.9mm CBx and a newly developed 1.1mm mini-cryoprobe with an 2.6 mm sheath allowing encapsulation of the sample (TTSCbx). Activation times for TTSCbx were 2,4,6,8 and 10 seconds.

RESULTS: Mean procedure time was 38.7sec for TTSCbx, 59.4sec for CBx and 30.2sec for FBx (p=0.13). Mean fluoroscopic duration was 3.2sec for TTSCbx, 2.7sec for CBx and 5.3sec for FBx (p=.0006). There was no significant bleeding in any procedure. Histopathologic Assessability Index (HAI) was 3.32 for TTSCbx, 3.28 for CBx and 1 for FBx(p=0.0002). There was no significant difference in HAI between TTSCbx and CBx (p > 0.9999). The average % alveolated tissue of TTSCbx was 64.25%, 70.05% for CBx and 58.03% for FBx (p=0.016).

CONCLUSIONS: TTSCbx samples are superior to FBx in size and quality with no difference in complications. TTSCbx sample retrieval is feasible and effective while the bronchoscope remained within the central airways.

CLINICAL IMPLICATIONS: TTSCbx is superior to FBx and may obviate the need for open lung biopsy. Human studies are needed to confirm these findings.

DISCLOSURE: Lonny Yarmus: University grant monies: Erbe Sixto Arias: University grant monies: Erbe David Feller-Kopman: University grant monies: Erbe Roy Semaan: University grant monies: Erbe Bernice Frimpong: University grant monies: Erbe Ricardo Ortiz: University grant monies: Erbe Karen Oakjones-Burgess: University grant monies: Erbe Falco Fend: University grant monies: Erbe Hans Boesmueller: University grant monies: Erbe Hans Lee: University grant monies: Erbe

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