Endobronchial tumor debulking with a flexible cryoprobe for immediate treatment of malignant stenosis

Received 16 March 2009; received in revised form 9 May 2009; accepted 20 June 2009. published online 28 August 2009.

Objective

In addition to use of a laser, argon plasma coagulation, electrocautery, or coring with a rigid bronchoscope, tumor debulking with a flexible cryoprobe is used for therapeutic bronchoscopy with an immediate effect for endobronchial pathologies. We performed this analysis to determine the usefulness, efficacy, and safety of the flexible cryorecanalization in a large population under routine conditions.

Methods

We identified 225 bronchoscopic interventions that were done as cryorecanalization with a flexible cryoprobe. All patients had symptomatic airway stenosis. We determined the endoscopic success rate and safety (bleeding and perforation) of the procedure.

Results

Successful cryorecanalization was achieved in 205 (91.1%) of 225 patients. The flexible cryoprobe was used with all patients, in most patients in combination with flexible bronchoscopy and only in a minority (n = 31, 13.8%) in combination with a rigid bronchoscope. Additional interventional techniques used were endobronchial stents (n = 11, 4.9%) and argon plasma coagulation (n = 37, 16.4%). Mild bleeding (if ice-cold NaCl or epinephrine solution was necessary) occurred in 9 (4.0%) patients, moderate bleeding (if argon plasma coagulation or a bronchus blocker was required) occurred in 18 (8.0%) patients, and severe bleeding (events with hemodynamic instability) never occurred.

Conclusions

Cryorecanalization with the flexible cryoprobe for treatment of symptomatic endobronchial tumor stenosis is a safe technique with a high success rate and immediate treatment effect.

CTSNet classification: 10, 15

Abbreviations and Acronyms: APC, argon plasma coagulation, CR, cryorecanalization, Nd-YAG, neodymium-doped yttrium aluminum garnet

a Center of Internal Medicine, Clinic of Internal Medicine II, University of Ulm, Ulm, Germany

b Clinic of Pneumology and Internal Medicine, Red Cross Hospital, Stuttgart, Germany

c Department of Internal Medicine II, University of Tübingen, Tübingen, Germany

d Department of Pneumology, University Hospital of Bern (Inselspital) and University of Bern, Bern, Switzerland

e Medical Clinic I, University Clinic Aachen, Aachen, Germany

Address for reprints: Christian Schumann, MD, University of Ulm, Clinic of Internal Medicine II, Albert-Einstein-Allee 23, 89081 Ulm, Germany.

Disclosures: M.H., A.J.B., and J.H. report lecture fees from ERBE, the manufacturer of the cryoprobe.

∗ C.S., M.H., and J.H contributed equally to this article.

PII: S0022-5223(09)00877-0

doi:10.1016/j.jtcvs.2009.06.023

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