Safety and diagnostic yield of transbronchial lung cryobiopsy by flexible bronchoscopy using laryngeal mask airway in diffuse and localized peripheral lung diseases: A single-center retrospective analysis of 326 cases

Manoj Kumar Goel, Ajay Kumar, Gargi Maitra, Balkar Singh, Sunita Ahlawat, Priti Jain, Neeraj Garg, R K Verma, Manoj Kumar Goel, Ajay Kumar, Gargi Maitra, Balkar Singh, Sunita Ahlawat, Priti Jain, Neeraj Garg, R K Verma

Abstract

Background: Intubation with either an endotracheal tube or a rigid bronchoscope is generally preferred to provide airway protection as well as to manage unpredictable complications during transbronchial lung cryobiopsy (TBLC). The laryngeal mask airway has been described as a safe and convenient tool for airway control during bronchoscopy.

Aims and objectives: In this study, we evaluated the safety and outcome of using a laryngeal mask airway (LMA) as a conduit for performing TBLC by flexible video bronchoscopy (FB).

Methods: We retrospectively analyzed the database of the patients who underwent TBLC between November 2015 and September 2019. The procedure was performed using FB through LMA under general anesthesia. Prophylactic occlusion balloon was routinely used starting January 2017 onwards. Radial endobronchial ultrasound (R-EBUS) guidance was used for TBLC in the localized lung lesions when deemed necessary. Multidisciplinary consensus diagnostic yield was determined and periprocedural complications were recorded.

Results: A total of 326 patients were analysed. The overall diagnostic yield was 81.60% (266/326) which included a positive yield of 82.98% (161/194) in patients with diffuse lung disease and 79.54% (105/132) in patients with localized disease. Serious bleeding complication occurred in 3 (0.92%) cases. Pneumothorax was encountered in 8 (2.45%) cases. A total of 9 (2.76%) cases had at least 1 major complication.

Conclusion: This study demonstrates that the use of LMA during TBLC by flexible bronchoscopy allows for a convenient port of entry, adequate airway support and effective endoscopic management of intrabronchial haemorrhage especially with the use of occlusion balloon.

Keywords: Cryobiopsy; interstitial lung disease; radial endobronchial ultrasound; transbronchial biopsy.

Conflict of interest statement

None

Figures

Figure 1
Figure 1
Occlusion balloons: (a) The assistant is firmly gripping the Fogarty Balloon catheter with his right hand at its proximal exit from the laryngeal mask airway which he also stabilizes with his left hand. The operator maneuvers the bronchoscope through the laryngeal mask airway. (b) An Arndt endobronchial blocker is advanced through the blocker port of the Arndt Multiport Adapter, and a fiber-optic bronchoscope is introduced through its fiber-optic port. The occlusion balloon is secured by tightening the blocker port of the Arndt Multiport Adapter
Figure 2
Figure 2
Tissue specimens obtained with transbronchial lung cryobiopsy: (a) Extracted biopsy sample attached to the tip of the cryoprobe, (b) transbronchial lung cryobiopsy samples from one of the patients, (c) a biopsy specimen measuring 8 mm in diameter, (d) fixed, stained, and cut sections of cryobiopsy specimen for a histopathology examination

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