Tuberc Respir Dis.  2010 Jan;68(1):6-9.

Bronchoscopic Cryotherapy in Patients with Central Airway Obstruction

• Lyu J
• Song JW
• Hong SB
• Oh YM
• Shim TS
• Lim CM
• Lee SD
• Koh Y
• Kim WS
• Kim DS
• Choi CM

Abstract

BACKGROUND
The efficacious use of interventional bronchoscope for patients with central airway obstruction due to malignant or benign lesions has been proven. Among many therapeutic bronchoscopic procedures, endobronchial cryotherapy is an established recanalization method for the obstruction of the respiratory tract. Recently, the use of this procedure has been increasing in Korea. However, limited data are available in the literature regarding its efficacy in Korea.
METHODS
Thirty patients, who had been treated with a flexible cryoprobe for cryotherapy were enrolled; clinical characteristics and treatment outcomes were analyzed. The patients had been treated with the technique using nitrous oxide as a cryogen under local anesthesia. Objective outcomes were 3 different degrees of therapeutic success by use of follow-up bronchoscopic findings as follows: successful, partially successful, and unsuccessful response. Subjective outcomes were evaluated as an improvement in symptoms.
RESULTS
The mean age of enrolled patients was 59+/-11 years and there was a male (22/30) dominance. Twenty-three patients had malignant tumor and 7 patients had benign lesions with central airway obstruction. Successful recanalization was achieved in 11 (37%) patients, and partially successful response was achieved in 15 (50%) patients. Dyspnea was improved in 84.2% (16/19) of patients. At least one respiratory symptom was resolved in 91.3% (21/23) patients. Seven patients (23.3%) needed additional bronchoscopic electrocautery because of the bleeding as a complication of cryotherapy.
CONCLUSION
Endobronchial cryotherapy is an effective and less expensive procedure for the management of central airway obstruction. However, the procedure should be performed under the preparing for an emergency situation, such as massive bleeding.

Keyword

Bronchoscopy; Cryotherapy; Airway Obstruction

MeSH Terms

Airway Obstruction
Anesthesia, Local
Bronchoscopes
Bronchoscopy
Cryotherapy
Dyspnea
Electrocoagulation
Emergencies
Follow-Up Studies
Hemorrhage
Humans
Korea
Male
Nitrous Oxide
Respiratory System
Nitrous Oxide

Reference

1. Brodsky JB. Bronchoscopic procedures for central airway obstruction. J Cardiothorac Vasc Anesth. 2003. 17:638–646.

2. Smith EL, Hann DM, Ahles TA, Furstenberg CT, Mitchell TA, Meyer L, et al. Dyspnea, anxiety, body consciousness, and quality of life in patients with lung cancer. J Pain Symptom Manage. 2001. 21:323–329.

3. You HJ, Choi PR, Park EH, Yang JH, Choi IS, Kim HJ, et al. Bronchoscopic electrocautery with electroprobe and diathermic snare in patients with malignant airway obstruction. Tuberc Respir Dis. 2005. 59:504–509.

4. Jung JY, Lee SY, Kim DH, Lee KJ, Lee EJ, Kang EH, et al. Clinical benefits and complications of cryotherapy in advanced lung cancer with central airway obstruction. Tuberc Respir Dis. 2008. 64:272–277.

5. Bolliger CT, Sutedja TG, Strausz J, Freitag L. Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents. Eur Respir J. 2006. 27:1258–1271.

6. Maiwand MO, Homasson JP. Cryotherapy for tracheobronchial disorders. Clin Chest Med. 1995. 16:427–443.

7. Hetzel M, Hetzel J, Schumann C, Marx N, Babiak A. Cryorecanalization: a new approach for the immediate management of acute airway obstruction. J Thorac Cardiovasc Surg. 2004. 127:1427–1431.

8. Mathur PN, Wolf KM, Busk MF, Briete WM, Datzman M. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. Chest. 1996. 110:718–723.

9. Gorenstein A, Neel HB, Sanderson DR. Transbronchoscopic cryosurgery of respiratory structures: experimental and clinical studies. Ann Otol Rhinol Laryngol. 1976. 85:670–678.

10. Cooper IS, Lee AS. Cryostatic congelation: a system for producing a limited, controlled region of cooling or freezing of biologic tissues. J Nerv Ment Dis. 1961. 133:259–263.

11. Homasson JP, Renault P, Angebault M, Bonniot JP, Bell NJ. Bronchoscopic cryotherapy for airway strictures caused by tumors. Chest. 1986. 90:159–164.

12. Chan AL, Yoneda KY, Allen RP, Albertson TE. Advances in the management of endobronchial lung malignancies. Curr Opin Pulm Med. 2003. 9:301–308.

13. Homasson JP, Pecking A, Roden S, Angebault M, Bonniot JP. Tumor fixation of bleomycin labeled with 57 cobalt before and after cryotherapy of bronchial carcinoma. Cryobiology. 1992. 29:543–548.

14. Vergnon JM, Schmitt T, Alamartine E, Barthelemy JC, Fournel P, Emonot A. Initial combined cryotherapy and irradiation for unresectable non-small cell lung cancer. Preliminary results. Chest. 1992. 102:1436–1440.