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Pulmonary Procedures |

The Use of Large Endobronchial Forceps and Recombinant Thrombin in the Diagnosis of Interstitial Lung Disease FREE TO VIEW

Rohan Arya, MD; Ziad Boujaoude, MD; Haroon Raja, MD; Dany Gaspard, MD; William Rafferty, MD; Wissam Abouzgheib, MD
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Cooper University Hospital, Camden, NJ


Chest. 2015;148(4_MeetingAbstracts):821A. doi:10.1378/chest.2275043
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Abstract

SESSION TITLE: Interventional Pulmonology Posters II

SESSION TYPE: Original Investigation Poster

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

PURPOSE: The workup of interstitial lung disease (ILD) often requires surgical lung biopsy. Bronchoscopic lung biopsy is often non-conclusive due to the size and non-architecture preserving nature of samples. We present a series of suspected ILD where a large biopsy forceps (2.8 mm) was used to obtain samples. All biopsies were followed by instillation of local thrombin to prevent bleeding.

METHODS: We performed large forceps trans-bronchialbiopsies using a large forceps 2.8 mm in patients with undiagnosed ILD under fluoroscopic guidance. We report 10 consecutive patients with an adequate parenchymal samples. After each biopsy we instilled 5 ml thrombin to prevent any bleeding. Inclusion criteria included; suspected ILD, previous bronchoscopy with small forceps biopsy with non-conclusive diagnosis. Exclusion criteria included; bullous lung disease, coagulopathy, hypoxemic respiratory failure, acute exacerbation of ILD and hemodynamic instability.

RESULTS: Eleven consecutive patients with radiographic findings of ILD who underwent large forceps biopsies are reported. The average patient age was 51.9. All patients tolerated procedure well, no major bleeding or pneumothorax were observed. The average specimen size was 3.5 mm. ILD diagnoses made were lymphocytic interstitial pneumonia (1), non specific interstitial penumonia (2), organizing pneumonia (3), respiratory bronchiolitis interstitial lung disease (1), early phase diffuse alveolar damage (1), hypersensitivity pneumonitis (1), eosinophilic pneumonia (1) and giant cell granulomas (1).

CONCLUSIONS: In our case series we found that large forceps trans-bronchial lung biopsies followed by thrombin instillation in undiagnosed interstitial processes yielded a large enough tissue specimen to make the diagnosis of interstitial disease without major complications. We advocate the use of this method prior to surgical lung biopsy. A study by Loube et al showed that larger specimens with more alveolar tissue was obtained with large forceps biopsies without increased incidence of bleeding. To our knowledge no previous study has looked at the use of large endobronchial forceps biopsies to evaluate for ILD or the use of prophylactic thrombin instillation to prevent bleeding.

CLINICAL IMPLICATIONS: Our case series shows that the use of a larger endobronchial forceps (2.8mm) can yield larger tissues samples from which diagnosis of ILD can be made. We advocate the use of this method prior to surgical lung biopsy as it may prevent the necessity of the more invasive surgerical procedure.

DISCLOSURE: The following authors have nothing to disclose: Rohan Arya, Ziad Boujaoude, Haroon Raja, Dany Gaspard, William Rafferty, Wissam Abouzgheib

We instill recombinant thrombin directly into the local airway after large forceps transbronchial lung biopy to prevent bleeding.


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