Cryotherapy in the paediatric airway: Indications, success and safety.
airway obstruction
cryobiopsy
cryotherapy
foreign body removal
interventional bronchoscopy
paediatric bronchoscopy
Journal
Respirology (Carlton, Vic.)
ISSN: 1440-1843
Titre abrégé: Respirology
Pays: Australia
ID NLM: 9616368
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
13
12
2021
accepted:
15
08
2022
pubmed:
3
9
2022
medline:
19
10
2022
entrez:
2
9
2022
Statut:
ppublish
Résumé
Cryotherapy in interventional bronchoscopy is a new treatment modality, which has recently been made available for the paediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this study was to assess indications, success rates and complications of airway cryotherapy in children. Bronchoscopists from medical centre performing cryotherapy in patients between 0 and 18 years were invited to participate in a prospective study based on an online questionnaire. Patient and participant data were collected between June 2020 and June 2021. A total of 69 cryotherapy procedures were performed in 57 patients a for three main indications: Biopsy (30), restoration of airway patency (23) and foreign body aspiration (16). The overall success rate was 93%, the remaining 7% were performed for foreign body removal and required a switch of technique. Restoration of airway patency was successfully applied in various pathologies, including mucus plugs, bronchial casts and post traumatic stenosis. The diagnostic yield of transbronchial biopsies was 96%. No severe complications were encountered; one pneumothorax following a cryobiopsy required a chest drain for 48 h. No child was admitted to intensive care or died from a procedural complication. In this largest paediatric case collection to date, cryotherapy was safe and carried a high success rate. Cryobiopsy compares favourably to the widely used forceps biopsy and could replace it in the future. Paediatric bronchoscopists are encouraged to add cryotherapy to their armamentarium of airway interventions.
Sections du résumé
BACKGROUND AND OBJECTIVE
Cryotherapy in interventional bronchoscopy is a new treatment modality, which has recently been made available for the paediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this study was to assess indications, success rates and complications of airway cryotherapy in children.
METHODS
Bronchoscopists from medical centre performing cryotherapy in patients between 0 and 18 years were invited to participate in a prospective study based on an online questionnaire. Patient and participant data were collected between June 2020 and June 2021.
RESULTS
A total of 69 cryotherapy procedures were performed in 57 patients a for three main indications: Biopsy (30), restoration of airway patency (23) and foreign body aspiration (16). The overall success rate was 93%, the remaining 7% were performed for foreign body removal and required a switch of technique. Restoration of airway patency was successfully applied in various pathologies, including mucus plugs, bronchial casts and post traumatic stenosis. The diagnostic yield of transbronchial biopsies was 96%. No severe complications were encountered; one pneumothorax following a cryobiopsy required a chest drain for 48 h. No child was admitted to intensive care or died from a procedural complication.
CONCLUSION
In this largest paediatric case collection to date, cryotherapy was safe and carried a high success rate. Cryobiopsy compares favourably to the widely used forceps biopsy and could replace it in the future. Paediatric bronchoscopists are encouraged to add cryotherapy to their armamentarium of airway interventions.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
966-974Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.
Références
Arnott J. On the remedial and anaesthetic uses of intense cold. Mon J Med Sci. 1854;10:32-9.
Grant CSVA. Cryotherapy. In: Goldfarb S, Piccione J, editors. Diagnostic and interventional bronchoscopy in children. (Respiratory Medicine). Cham: Springer International Publishing; 2021.
Srikanta JT, Swarna S, Shylendra DS, Mehta R. Transbronchial lung cryobiopsy for diagnosis of pediatric interstitial lung disease. Indian Pediatr. 2018;55:519-20.
Spencer CY, Millman J, Veiga K, Vicencio AG. Airway autoimmune inflammatory response (AAIR) syndrome: an asthma-autoimmune overlap disorder? Pediatrics. 2018;141:e20170138.
Faro A, Visner G. The use of multiple transbronchial biopsies as the standard approach to evaluate lung allograft rejection. Pediatr Transplant. 2004;8:322-8.
Benden C, Harpur-Sinclair O, Ranasinghe AS, Hartley JC, Elliott MJ, Aurora P. Surveillance bronchoscopy in children during the first year after lung transplantation: is it worth it? Thorax. 2007;62:57-61.
Visner GA, Faro A, Zander DS. Role of transbronchial biopsies in pediatric lung diseases. Chest. 2004;126:273-80.
Piccione J, Hysinger EB, Vicencio AG. Pediatric advanced diagnostic and interventional bronchoscopy. Semin Pediatr Surg. 2021;30:151065.
Ni C, Yu H, Han X, Meng C, Zhang Y. Clinical analysis of bronchoscopic cryotherapy in 156 pediatric patients. Pediatr Int. 2017;59:62-7.
Robinson M, Smiley M, Kotha K, Udoji T. Plastic bronchitis treated with topical tissue-type plasminogen activator and cryotherapy. Clin Pediatr. 2016;55:1171-5.
Kallam EF, Kasi AS, Patki R, Silva GL, Simon DM, Caltharp S, et al. Bronchoscopic interventions for plastic bronchitis in children without structural heart disease. Eur J Pediatr. 2021;180:3547-54.
Xu X, Ding H, Liu X, Zhu B, Feng Z. Emergency management for congenital tracheal stenosis with endoluminal stenting in pediatric intensive care units. Ther Adv Respir Dis. 2016;10:310-7.
Jiao A, Liu F, Lerner AD, Rao X, Guo Y, Meng C, et al. Effective treatment of post-intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy. Pediatr Investig. 2019;3:9-16.
Hetzel J, Kumpf M, Hetzel M, Hofbeck M, Baden W. Cryorecanalization of an obstructed bronchial stent in a 12-year-old boy. Respiration. 2011;82:290-3.
Wang H, Zhang J, Li D, Zhang N, Li J, Mao J. Efficacy of bronchoscopic therapies for bronchial mucoepidermoid carcinoma in children: results from six patients. Tumori. 2015;101:52-6.
Ozgul MA, Toru U, Acat M, Ozgul G, Cetinkaya E, Dincer HE, et al. A rare tumor of trachea: inflammatory myofibroblastic tumor diagnosis and endoscopic treatment. Respir Med Case Rep. 2014;13:57-60.
Zhang L, Yin Y, Zhang J, Zhang H. Removal of foreign bodies in children's airways using flexible bronchoscopic CO2 cryotherapy. Pediatr Pulmonol. 2016;51:943-9.
David AP, Xu MJ, Rosbe KW, Meyer AK, Gesthalter YB, Chan DK. Cryoprobe retrieval of an airway foreign body: a case report and literature review. Int J Pediatr Otorhinolaryngol. 2019;125:79-81.
Moslehi MA. Approach to foreign body aspiration in an infant using a cryoprobe. Respir Case Rep. 2020;9:4-7.
Davidsen JR, Skov IR, Louw IG, Laursen CB. Implementation of transbronchial lung cryobiopsy in a tertiary referral center for interstitial lung diseases: a cohort study on diagnostic yield, complications, and learning curves. BMC Pulm Med. 2021;21:67.
Hammer J, Trachsel D, Nicolai T, Weiss M, Eber E. Caution to use bronchoscopic CO2 cryotherapy for foreign body removal in children. Pediatr Pulmonol. 2016;51:889-91.
Eber E, Anton-Pacheco JL, de Blic J, Doull I, Faro A, Nenna R, et al. ERS statement: interventional bronchoscopy in children. Eur Respir J. 2017;50:1700901.
Rasch D, Kubinger KD, Moder K. The two-sample t test: pre-testing its assumptions does not pay off. Stat Pap. 2011;52:219-31.
Ravaglia C, Wells AU, Tomassetti S, Gurioli C, Gurioli C, Dubini A, et al. Diagnostic yield and risk/benefit analysis of trans-bronchial lung cryobiopsy in diffuse parenchymal lung diseases: a large cohort of 699 patients. BMC Pulm Med. 2019;19:16.
Kuse N, Inomata M, Awano N, Yoshimura H, Jo T, Tone M, et al. Management and utility of transbronchial lung cryobiopsy in Japan. Respir Investig. 2019;57:245-51.
Gershman E, Fruchter O, Benjamin F, Nader AR, Rosengarten D, Rusanov V, et al. Safety of cryo-transbronchial biopsy in diffuse lung diseases: analysis of three hundred cases. Respiration. 2015;90:40-6.
Gershman E, Ridman E, Fridel L, Shtraichman O, Pertzov B, Rosengarten D, et al. Efficacy and safety of trans-bronchial cryo in comparison with forceps biopsy in lung allograft recipients: analysis of 402 procedures. Clin Transplant. 2018;32:e13221.
Hagmeyer L, Theegarten D, Wohlschlager J, Hager T, Treml M, Herkenrath SD, et al. Transbronchial cryobiopsy in fibrosing interstitial lung disease: modifications of the procedure lead to risk reduction. Thorax. 2019;74:711-4.
Hetzel J, Maldonado F, Ravaglia C, Wells AU, Colby TV, Tomassetti S, et al. Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: expert statement from the cryobiopsy working group on safety and utility and a call for standardization of the procedure. Respiration. 2018;95:188-200.
Lang M, Brietzke SE. A systematic review and meta-analysis of endoscopic balloon dilation of pediatric subglottic stenosis. Otolaryngol Head Neck Surg. 2014;150:174-9.
Fernando HC, Dekeratry D, Downie G, Finley D, Sullivan V, Sarkar S, et al. Feasibility of spray cryotherapy and balloon dilation for non-malignant strictures of the airway. Eur J Cardiothorac Surg. 2011;40:1177-80.
Fernando HC, Sherwood JT, Krimsky W. Endoscopic therapies and stents for benign airway disorders: where are we, and where are we heading? Ann Thorac Surg. 2010;89:S2183-7.
Li AK, Ehrlich HP, Trelstad RL, Koroly MJ, Schattenkerk ME, Malt RA. Differences in healing of skin wounds caused by burn and freeze injuries. Ann Surg. 1980;191:244-8.
Bhora FY, Ayub A, Forleiter CM, Huang CY, Alshehri K, Rehmani S, et al. Treatment of benign tracheal stenosis using endoluminal spray cryotherapy. JAMA Otolaryngol Head Neck Surg. 2016;142:1082-7.
Mahajan AK, Patel PP, Garg R, Manley C, Ibrahim O, Mehta AC. Safety of laser and thermal therapy during rigid bronchoscopy using manual hand jet ventilation. Surg Technol Int. 2021;39:103-6.
Ratwani AP, Davis A, Maldonado F. Current practices in the management of central airway obstruction. Curr Opin Pulm Med. 2021;28:45-51.
Patel N, Patel M, Inja R, Krvavac A, Lechner AJ. Plastic bronchitis in adult and pediatric patients: a review of its presentation, diagnosis, and treatment. Mo Med. 2021;118:363-73.
Soyer T, Yalcin S, Emiralioglu N, Yilmaz EA, Soyer O, Orhan D, et al. Use of serial rigid bronchoscopy in the treatment of plastic bronchitis in children. J Pediatr Surg. 2016;51:1640-3.
Sriratanaviriyakul N, Lam F, Morrissey BM, Stollenwerk N, Schivo M, Yoneda KY. Safety and clinical utility of flexible bronchoscopic cryoextraction in patients with non-neoplasm tracheobronchial obstruction: a retrospective chart review. J Bronchology Interv Pulmonol. 2015;22:288-93.
Fruchter O, Kramer MR. Retrieval of various aspirated foreign bodies by flexible cryoprobe: in vitro feasibility study. Clin Respir J. 2015;9:176-9.
Swanson KL, Prakash UB, Midthun DE, Edell ES, Utz JP, McDougall JC, et al. Flexible bronchoscopic management of airway foreign bodies in children. Chest. 2002;121:1695-700.
Kim K, Lee HJ, Yang EA, Kim HS, Chun YH, Yoon JS, et al. Foreign body removal by flexible bronchoscopy using retrieval basket in children. Ann Thorac Med. 2018;13:82-5.
Endoh M, Oizumi H, Kanauchi N, Kato H, Ota H, Suzuki J, et al. Removal of foreign bodies from the respiratory tract of young children: treatment outcomes using newly developed foreign-body grasping forceps. J Pediatr Surg. 2016;51:1375-9.