Bronchoscopy – Interventional pulmonology
Versatile solutions for diagnosis and therapy of various disease states
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For your clinical challenges and disease patterns
Obstructing central airway tumor
Endobronchial cryobiopsy / endobronchial debulking for recanalization
Endobronchial cryobiopsies with the 2.4mm single-use probe
Removal of a lung tumor with monopolar snare, flexible single-use cryoprobe and APC
Recanalization with 1.7mm single-use cryoprobe
Indications for endobronchial cryobiopsy and cryotherapy
Contraindications for endobronchial cryobiopsy and cryotherapy
Bleeding management for endobronchial cryobiopsy and cryotherapy
How can the perforation risk be mitigated using cryoextraction?
Recanalization of endobronchial tumor with APC 2
Even with the combination of different sampling techniques (forceps, brush, needles, etc.) you cannot reach the diagnostic rate of cryobiopsy alone in endobronchial lesions.- In up to 91% of cases, you can restore airway patency by debulking an endobronchial tumor with cryotechnology – even in patients who cannot tolerate a lower FiO2.
- Unlike other biopsy techniques, you can increase the detection rate of activating EGFR mutations in NSCLC with bronchoscopic cryobiopsy.
- In terms of safety cryotechnology is superior to laser in bronchoscopic therapy of endobronchial tumors.
- Treat bleeding with APC if it occurs after debulking lesions with cryotechnology.
- Achieve hemostasis with APC around curvatures or tumor margins.
- You can reach a favorable safety profile and a quicker learning curve with APC in bronchoscopy compared to laser applications.
More scientific information
SUMMARY OF PUBLICATION
Hetzel J, et al: Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial. Eur Respir J. 2012 Mar;39(3):685-90.
In this randomized multicenter study, the authors compared cryobiopsy and conventional forceps sampling for diagnosis of endobronchial malignancies. 281 patients were randomized to receive endobronchial biopsies with forceps, and 282 had biopsies performed with a flexible cryoprobe. After obtaining biopsy samples, a blinded histological evaluation was performed. A definitive diagnosis was achieved in significantly more patients who underwent cryobiopsy (95.0%) than in those randomized to conventional forceps biopsy (85.1%, p<0.001), even though there was no difference in the incidence of significant bleeding. The authors concluded that 'Endobronchial cryobiopsy is a safe technique with superior diagnostic yield in comparison with conventional forceps biopsy.'
SUMMARY OF PUBLICATION
Ehab A, et al: Cryobiopsy versus forceps biopsy in endobronchial lesions, diagnostic yield and safety. Adv Respir Med. 2017;85(6):301-306.
This study aimed to evaluate the safety and diagnostic yield of cryobiopsy compared with forceps biopsy in endobronchial lesions. Two forceps biopsies and one cryobiopsy (reusable cryoprobe, 2.4mm) were taken from the same patient in a randomized sequence. Samples obtained with cryobiopsy were significantly larger than those obtained with forceps biopsy (5.9mm ± 2.3 vs 2.5mm ± 0.8, p = 0.001). The diagnostic yield of cryobiopsy was significantly higher than that with forceps biopsy (74.5% versus 51.1%, p = 0.001). Mild and moderate grades of bleeding were reported in both techniques, with no significant difference and no severe bleeding. The authors concluded that 'Cryobiopsy represents a safe and effective tool to obtain larger tissue samples of good quality, with higher diagnostic yield in comparison to standard forceps samples. However, bleeding occurred more frequently after cryobiopsy than with forceps biopsy, but without severe adverse effects.'
Products for this intervention
Product finder
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Flexible cryoprobe
single-use, Ø 2.4mm, length 1,150mm
No. 20402-411
Flexible cryoprobe
single-use, ø 1.7mm, length 1150mm
No. 20402-410
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm, with oversheath, length 817mm, with oversheath ø 2.6mm
No. 20402-401
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm with oversheath, length 757mm, with oversheath ø 2.6mm
No. 20402-402
92% of your colleagues confirm that the cryoprobe with oversheath can replace biopsy forceps.- The oversheath protects your bronchoscope against the thermal influence of the cryoprobes (1,1mm) during biopsy retrieval.
- The atraumatic oversheat allows you to perform a quick biopsy with 1.1mm cryoprobe through the bronchoscope.
- With the oversheath extracted, suction is constantly enabled by an integrated seal in the multi-adapter.
- ERBECRYO® 2 can be integrated with electrosurgical and APC units on a cart.
FiAPC Probe 1500 A
ø 1.5mm, flexible, length 1.5m
No. 20132-220
FiAPC probe 2200 A
ø 2.3mm, flexible, length 2.2m
No. 20132-221
- Devitalize tissue anomalies with APC. FiAPC Membrane Filter prevents contamination
- The integrated safety filter in the FiAPC probe prevents cross-contamination of the device and the probe.
- You can apply APC axially and tangentially.
Pulmonary hemorrhage
Removal of blood clots
Blood clot cryoextraction of a large central cast in piecemeal-technique using the 1.7mm probe
Blood clot cryoextraction – ERS Congress 2021
Bleeding management after endobronchial recanalization with flexible FiAPC probe 1500 A
Hemostasis of tracheobronchial bleeding with APC 2
- Extract blood clots safely, quickly and successfully with cryotechnology in more than 90% of cases.
- In several cases, you can extract blood clots rapidly en bloc with cryotechnology.
- Avoid the use of a rigid bronchoscope by removing blood clots with an endotracheal and flexible technique.
- You can also apply cryoextraction at the bedside for intensive care patients.
- You can even perform cryoextraction of blood clots in anticoagulated patients on ECMO.
More scientific information
MEDICAL INSIGHTS ePAPER
Bronchoscopic removal of blood clots in the central airway. Role of cryoextraction for restoring of airway patency.
Blood clot removal can be achieved with different methodologies. However, guidelines as to when to choose which treatment option are not yet present. Flexible bronchoscopy is now the main method used and can be carried out at bedside. Most blood clots can be removed with suction, lavage and flexible forceps. However, these methods include the risk of bleeding and airway trauma and might not be successful due to the fragile structure of blood clots. Rigid bronchoscopy requires general anesthesia and bedside application can be challenging. The use of balloon catheters increases the risk of bronchial injury and mucosa damage, and topical thrombolytic agents pose a risk for rebleeding.
MEDICAL INSIGHTS PODCAST
Dr. Erik Hysinger, Assistant Professor in the Department of Pediatrics at Cincinnati Children’s Hospital: Bronchoscopic procedures for pediatric patients and use of cryotechnology for treatment of foreign body aspiration
„My story goes back actually to my residency training. I was very interested in pulmonology and respiratory mechanics and had a lecture to do a procedural month or elected to do a procedural month and went over to the adult hospital at Vanderbilt in Nashville, Tennessee, and did some work with the interventional pulmonology group there. And what I was seeing that they were doing blew my mind. And the ability to be able to see the airway up close and be able to intervene on the airway really piqued my interest and started pursuing that even further in fellowship, doing much more work with pediatrics flexible bronchoscopy.“
MEDICAL INSIGHTS PODCAST
Dr. Erik Hysinger, Assistant Professor in the Department of Pediatrics at Cincinnati Children’s Hospital: Debulking granulation tissue using cryotechnology as opposed to other modalities and the role this technology plays for palliation of central airway tumors.
„We were just doing a case of this last week for a young lady who's had really a very difficult time with formation of granulation tissue. The kids that I see granning the most are going to be patients that have long term needs for trachestomies and long term needs for ventilation. That's probably the most common area that we see. And we can see it from anything from suction trauma to problems with the cuffs, creating damage to the tissue or from the tracheal tube itself, rubbing into the mucosa and creating inflammation distally. Another place where we've seen this has been in patients that are having endobronchial stents. Oftentimes similar processes.“
Products for this interventionProduct finderProduct finder
Flexible cryoprobe
single-use, Ø 2.4mm, length 1,150mm
No. 20402-411
Flexible cryoprobe
single-use, ø 1.7mm, length 1150mm
No. 20402-410
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm, with oversheath, length 817mm, with oversheath ø 2.6mm
No. 20402-401
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm with oversheath, length 757mm, with oversheath ø 2.6mm
No. 20402-402
FiAPC Probe 1500 A
ø 1.5mm, flexible, length 1.5m
No. 20132-220
FiAPC probe 2200 A
ø 2.3mm, flexible, length 2.2m
No. 20132-221
- Tissue anomalies you can devitalize with APC.
- The integrated safety filter in the FiAPC probe prevents cross-contamination of the device and probe.
- You can apply APC axially and tangentially.
Interstitial lung diseases
Transbronchial cryobiopsy
Transbronchial cryobiopsy with single-use cryoprobe
Sampling of peripheral lung nodules with cryo – ERS Congress 2021
Mediastinal cryobiopsy for lymphadenopathy – ERS Congress 2021
Transbronchial cryobiopsy with rigid intubation for ILD diagnosis using flexible single-use cryoprobe and ERBECRYO® 2
Removal of a lung tumor with monopolar snare, flexible single-use cryoprobe and APC
- Transbronchial cryobiopsy is superior to transbronchial forceps biopsy with regard to the diagnostic yield in cases of idiopathic interstitial pneumonia and interstitial lung disease with a known cause or association.
- This method is a safe and effective way to diagnose lung transplant rejection.
- The 1.1mm cryoprobe and oversheath enables you to extract biopsy material through the working channel of a therapeutic bronchoscope (2.8mm working channel).
- Transbronchial cryobiopsy is safe and effective for the diagnosis of lung allograft rejection.
More scientific information
MEDICAL INSIGHTS ePAPER
Transbronchial cryobiopsy for the diagnosis of interstitial lung diseases (ILDs). Current procedural guidance for interventional bronchoscopists according to the literature.
For idiopathic pulmonary fibrosis (IPF) and fibrotic hypersensitivity pneumonitis, recommendations have been made for TBCB over SLB. A lack of procedural standardization and high degree of interobserver variability between different institutions make it difficult to recommend TBCB over SLB in general. To this end, common questions on the application of Erbe flexible cryoprobes as an indispensable part of TBCB need to be addressed.
MEDICAL INSIGHTS ePAPER
Transbronchial lung cryobiopsy (TBLC) for diagnosis of interstitial lung diseases (ILD). COLDICE study results and latest CHEST guidelines
Surgical lung biopsy (SLB) until now has been the gold standard recommended in different guidelines but is associated with significant morbidity, with complications including postoperative pneumothorax, pneumonia and respiratory failure, as well as significant mortality, indicated at 1.7 %. Given these risks and the often detrimental state of suspected ILD patients, reported SLB rates in ILD are lower than estimated necessary and in 2016 reached only 8 % in Europe. Consequently, transbronchial lung cryobiopsy (TBLC), a minimal invasive technique allowing biopsy without major surgery, is increasingly used in diagnosis of ILD. The COLDICE study (Cryobiopsy versus Open Lung biopsy in the Diagnosis of Interstitial lung disease) has addressed both approaches.
MEDICAL INSIGHTS ePAPER
Transbronchial cryobiopsy for sampling of mediastinal lesions. Evaluation of transbronchial needle aspiration and the flexible single-use 1.1mm cryoprobe for sampling of mediastinal lesions
In their present publication Transbronchial mediastinal cryobiopsy in the diagnosis of mediastinal lesions: a randomised trial, the working groups from Thoraxklinik Heidelberg, Germany and Third Military Medical University Chongqing, People's Republic of China, assess the safety and efficacy of linear EBUS-guided transbronchial mediastinal cryobiopsy.
MEDICAL INSIGHTS PODCAST
Prof. Venerino Poletti, head of the Department of Respiratory and Chest Diseases at the Ospedale G.B. Morgagni in Forli and Dr. Hari Kishan Gonuguntla, lead consultant Interventional Pulmonologist at the Yashoda Hospital in Secunderabad: Transbronchial cryobiopsy of mediastinal lymph nodes
Both currently recommend transbronchial mediastinal cryobiopsy to any bronchoscopist who has experience and confidence in performing the EBUS-TBNA. In cases of granulomatous and lymphoproliferative diseases, the features of biopsy specimens procured using this technique can prove to have advantages over those provided by needle biopsy. Dr. Hari Kishan: „My pathologist's reaction to this first samples, especially when it comes to malignant nodes or metastatic disease. They'll be more happy because size is a very big advantage here. We definitely get more samples than the conventional needles, but we have to see being TB endemic country how this technology evolves.“ Prof. Poletti: „I think that cryotechnology is used to avoid bleeding or to control bleeding. We have bleeding when we have biopsy in the peripheral of the lung, because you tear the bronchial artery or the pulmonary veins or the pulmonary artery, but in the mediastinal lesions. First of all, you can control the best colorization by ultrasound and then usually biopsy, not in area where you have large vessels. I think it's very easy to have a very low rate of bleeding in this context.“
Products for this interventionProduct finder
Flexible cryoprobe
single-use, ø 1.7mm, length 1150mm
No. 20402-410
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm, with oversheath, length 817mm, with oversheath ø 2.6mm
No. 20402-401
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm with oversheath, length 757mm, with oversheath ø 2.6mm
No. 20402-402
- The single-use cryoprobes provide you with consistent technical performance and improve reproducibility due to consistent effects on the target tissue.
- Control the positioning of the single-use cryoprobes by X-ray imaging.
- The timer provides visual and acoustic feedback of the freezing time.
Peripheral pulmonary lesions
Peripheral cryobiopsy
Sampling of peripheral lung nodules with cryo – ERS Congress 2021
- With the flexible 1.1mm cryoprobe you can achieve an accurate biopsy of peripheral lung lesions. This reduces deflection of the rEBUS guide sheath when inserting the cryoprobe.
- Quantify the expression of PD-L1 (programmed cell death ligand 1) in bronchial neoplasm with suitable material from cryobiopsy.
- Next-generation sequencing is also possible from cryobiopsy material in a higher quality compared to EBUS-guided transbronchial needle aspiration.
- You can also use cryobiopsies for immunohistochemical evaluation of bronchial neoplasia.
- Achieve deeper sampling in peripheral lung lesions with cryobiopsy compared to standard forceps. This is beneficial when sampling lesions with incomplete mucosal invasion in a difficult or adjacent location.
More scientific information
MEDICAL INSIGHTS ePAPER
Peripheral cryobiopsy for solitary pulmonary nodules. 1.1mm flexible single-use cryoprobe for the diagnosis of sub-solid lesions.
Ground-glass opacity lesions (GGOs) respresent a subgroup of sub-solid lesions, which are characterized by an increased opacity of lung tissue on high- resolution computed tomography. Different techniques have been described in the literature for biopsy of peripheral lesions (transthoracic needle aspiration, transbronchial forceps biopsy or cryobiopsy and surgical lung biopsy). Using interventional pulmonological procedures, GGOs can be harder to diagnose compared to solid lesions. Jiang et al. conducted the first study evaluating the clinical use of the 1.1mm flexible single-use cryoprobe on peripheral cryobiopsy specifically for the diagnosis of GGOs.
Products for this interventionProduct finder
Flexible cryoprobe
single-use, ø 1.7mm, length 1150mm
No. 20402-410
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm, with oversheath, length 817mm, with oversheath ø 2.6mm
No. 20402-401
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm with oversheath, length 757mm, with oversheath ø 2.6mm
No. 20402-402
- Miniaturization extends your clinical utility due to compatibility with navigation catheters and small bronchoscopes (1.7mm and 1.2mm working channels).
- Reliable technical performance supports consistent target tissue effects.
Aspiration
Foreign body removal
- With cryobronchoscopy you can safely extract blood clots, mucous plugs, plastic bronchitis and foreign bodies. This is also possible at the bedside. In many cases, there is no need for a rigid bronchoscope.
- Extract foreign bodies reliably from the airways of children with cryotechnology.
- Well suited for various objects with brittle textures or even slippery or smooth surfaces (extraction by cryoadhesion).
- Just spray the foreign body with saline solution; this allows immediate extraction of foreign bodies with low water content.
Ingestion of a peanut - EXCEPTIONAL PATIENT STORIES
More scientific information
SUMMARY OF PUBLICATION
Moslehi, Mohammad Ashkan (2020): Foreign Body Retrieval by Using Flexible Cryoprobe in Children. Journal of bronchology & interventional pulmonology.
This retrospective study evaluated the extraction of aspirated foreign bodies in children, using flexible bronchoscopy and a cryoprobe (reusable, 1.9mm). 50 children ranging in age from 7 months to 15 years underwent cryoextraction under mild general anesthesia. The most common location of foreign bodies was the right main bronchus, followed by the trachea, left main bronchus and subglottis. The most common aspirated foreign bodies were nuts, followed by raw vegetables, fruit particles, seeds, and grain seeds. All patients tolerated the procedure well with no major complications. The authors concluded that “Using cryoextraction can be a reliable and preferred method with minimal complications for extracting airway foreign bodies among children, especially those that have a friable texture.”
SUMMARY OF PUBLICATION
David, Abel P et al (2019): Cryoprobe retrieval of an airway foreign body: A case report and literature review. International journal of pediatric otorhinolaryngology 125, pp. 79–81.
This case reports on a 7-year-old boy with clinical and radiographic evidence of foreign body aspiration (push pin) with a two-week delay in diagnosis. Several unsuccessful attempts were made to remove the push pin using traditional flexible forceps through the main channel of a bronchoscope without. Although a firm grasp on the metal pin was initially achieved, it could not dislodge the object, which was firmly embedded in the bronchial wall with circumferential granulation. A cryoprobe (reusable, 1.9mm) was then forwarded through a flexible bronchoscope with suspension laryngoscopy and spontaneous ventilation. Activation of the cryoprobe for roughly 5 seconds, while in contact with the protruding metal portion of the push pin, caused the pin to freeze onto the tip of the probe and enabled successful removal of the foreign body. The authors concluded that “The cryoprobe and flexible bronchoscope through suspension laryngoscopy should be added to any airway surgeon's armamentarium for airway foreign body removal.”
Products for this interventionProduct finder
Flexible cryoprobe
single-use, Ø 2.4mm, length 1,150mm
No. 20402-411
Flexible cryoprobe
single-use, ø 1.7mm, length 1150mm
No. 20402-410
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm, with oversheath, length 817mm, with oversheath ø 2.6mm
No. 20402-401
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm with oversheath, length 757mm, with oversheath ø 2.6mm
No. 20402-402
- The atraumatic tip design facilitates smooth positioning of the single-use cryoprobe.
- The plug of the single-use cryoprobe helps to make connection and disconnection easy.
Benign central airway stenosis
Restoration of airway patency
- The risk of perforation and delayed stenosis is almost non-existent with cryodevitalization.
- Endobronchial mucosal cryobiopsy provides a higher content of submucosal tissue, glands and smooth muscle, as well as better preservation of the epithelial morphology compared to forceps biopsies.
- The effects of cryotherapy on microcirculation include vasoconstriction, endothelial injury and platelet aggregation; these lead to microthrombi formation and subsequent necrosis.
- Endobronchial mucosal cryobiopsies can be obtained in an outpatient setting.
- APC offers you a faster learning curve and a more favorable safety profile than laser ablation.
More scientific information
SUMMARY OF PUBLICATION
Inaty, Hanine et al: Unimodality and Multimodality Cryodebridement for Airway Obstruction. A Single-Center Experience with Safety and Efficacy. Annals of the American Thoracic Society 13 (6), S. 856–861.
This retrospective study reports effective and safe use of flexible cryoprobe (reusable, 2.4mm) for airway recanalization in 156 patients with malignant (n=88) and benign (n=68) airway obstruction. Cases of benign airway obstruction included blood clots (n=11), mucus plugs (n=1), granulation tissue (n=40), and benign tumors (n=6). Cryorecanalization achieved bronchoscopic airway patency in 95% of patients. For those with benign airway obstruction, complete or partial airway patency was accomplished in 56 (82%) and 9 (13%) of 68 patients, respectively. Improvement in symptoms occurred in 118 (82%) of 144 symptomatic patients. Serious complications were reported in 17 patients (11%) and included respiratory distress, severe bleeding, airway injury, and hemodynamic instability. The authors concluded that “Cryodebridement, when used alone or in combination with other endoscopic treatment modalities, appears to be safe and effective in treating endoluminal airway obstruction.”
SUMMARY OF PUBLICATION
Jung, Ye-Ryung et al: Recurred Post-intubation Tracheal Stenosis Treated with Bronchoscopic Cryotherapy. In: Internal medicine (Tokyo, Japan) 55 (22), S. 3331–3335.
This case reports on a 42-year-old woman with recurring post-intubation tracheal stenosis that was successfully treated with bronchoscopic cryotherapy (reusable, 2.4mm). She had a history of endotracheal intubation for three weeks, after which she experienced postintubation tracheal stenosis so that tracheal resection with end-to-end anastomosis was performed. Three weeks after the operation, recurrent tracheal stenosis was recognized that had formed as web-like fibrosis above the previous anastomosis site in the upper trachea. As her general condition was unfavorable for repeat surgery, cryotherapy with flexible bronchoscopy was performed. The patient experienced no immediate complications and after one month, airway patency was consistently well maintained and the patient was stable without dyspnea, stridor, or wheezing. Tracheal CT taken two years after cryotherapy showed no further stenosis at the old lesion site. The authors concluded that “Cryotherapy can be considered as an alternative or primary treatment for post-intubation tracheal stenosis”.
Products for this interventionProduct finderProduct finder
Flexible cryoprobe
single-use, Ø 2.4mm, length 1,150mm
No. 20402-411
Flexible cryoprobe
single-use, ø 1.7mm, length 1150mm
No. 20402-410
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm, with oversheath, length 817mm, with oversheath ø 2.6mm
No. 20402-401
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm with oversheath, length 757mm, with oversheath ø 2.6mm
No. 20402-402
- The 2.4mm probe provides you with the largest freezing area of all disposable cryoprobes
FiAPC Probe 1500 A
ø 1.5mm, flexible, length 1.5m
No. 20132-220
FiAPC probe 2200 A
ø 2.3mm, flexible, length 2.2m
No. 20132-221
- Tissue anomalies you can devitalize with APC.
- The integrated safety filter in the FiAPC probe prevents cross-contamination of the device and probe.
- You can apply APC axially and tangentially.
Exsudative pleural effusion of unknown origin
Medical Thoracoscopy
Pleuroscopic cryobiopsies using the flexible 1.7mm single-use cryoprobe with ERBECRYO® 2
- Extract deeper tissue samples with pleural cryobiopsy than is possible with standard forceps and achieve higher accuracy of disease staging (especially with mesothelioma).
- Pleuroscopic cryobiopsy during flex-rigid pleuroscopy is an effective, safe and convenient technique suitable for immunohistochemical and molecular analyses for malignant pleural mesothelioma diagnosis.
- Reduce the histological finding of nonspecific pleuritis to contribute to your definitive therapeutic decision in a larger fraction of patients.
- Quickly and easily avoid the difficulties of diffusely thickened and fibrotic pleural nodes that often occur with the lift-and-peel technique with forceps.
- APC offers you a faster learning curve and a better safety profile than is possible with laser treatment.
More scientific information
SUMMARY OF PUBLICATION
Dhooria, Sahajal et al: (2019): Pleural Cryobiopsy versus Flexible Forceps Biopsy in Subjects with Undiagnosed Exudative Pleural Effusions Undergoing Semirigid Thoracoscopy: A Crossover Randomized Trial (COFFEE Trial). Respiration; international review of thoracic diseases 98 (2), S. 133–141.
In this prospective study cryobiopsy (reusable, 2.4mm) and flexible forceps biopsy were compared for the diagnosis of pleural effusion in medical thoracoscopy. The same patients (n=50) underwent both forceps and cryobiopsy in a randomized order using semirigid thoracoscopy. Cryobiopsy specimens were significantly larger (median size 7.0mm vs. 4.0mm; p < 0.001) and had a significantly greater depth (down to the pleural fat or deeper: 65.2 vs. 40.8%; p = 0.02) than specimens from forceps biopsy. The duration of the cryobiopsy procedure was also significantly shorter than that of forceps biopsy (median duration 10 vs. 15 min; p < 0.001). The diagnostic yield (78.0% vs. 76.0%), difficulty of performing the biopsy, and severity of bleeding were similar in the two procedures. The authors concluded that “The diagnostic yield of pleural cryobiopsy was comparable to forceps biopsy during semirigid thoracoscopy.”
SUMMARY OF PUBLICATION
Botana Rial, Maribel et al: (2020): Diagnostic Yield and Safety of Pleural Cryobiopsy during Medical Thoracoscopy to Diagnose Pleural Effusion. A Systematic Review and Meta-Analysis. Archivos de bronconeumologia.
This meta-analysis compared the diagnostic yield and safety of pleural cryobiopsy and flexible forceps biopsy and evaluated 7 studies involving 356 patients. The diagnostic yield was comparable between the techniques (cryobiopsy: 95% (95% CI 92-97) vs. forceps biopsy: 91% (95% CI 87- 94)). Slight bleeding occurred more often during procedures with flexible forceps (85%, 95%; CI 79-90) than with cryobiopsy (67%, 95% CI 62-72; P< 0.001). Furthermore, cryobiopsy specimens were larger, and fewer artifacts were detected. A pooled analysis of the detection of molecular changes could not be performed. Heterogeneity was moderate to high, but the quality of the studies was acceptable. The authors concluded that “Pleural cryobiopsy is a safe technique with a high yield for etiological diagnosis of pleural effusion, and larger specimens with fewer artifacts are obtained. Molecular determinations should be investigated in more depth.”
Products for this interventionProduct finderProduct finder
Flexible cryoprobe
single-use, Ø 2.4mm, length 1,150mm
No. 20402-411
Flexible cryoprobe
single-use, ø 1.7mm, length 1150mm
No. 20402-410
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm, with oversheath, length 817mm, with oversheath ø 2.6mm
No. 20402-401
Flexible cryoprobe
single-use, ø 1.1mm, length 1150mm with oversheath, length 757mm, with oversheath ø 2.6mm
No. 20402-402
- The removal tool with the oversheat in combination with the 1.1mm cryoprobe makes the procedure more convenient
FiAPC Probe 1500 A
ø 1.5mm, flexible, length 1.5m
No. 20132-220
FiAPC probe 2200 A
ø 2.3mm, flexible, length 2.2m
No. 20132-221
- Tissue anomalies you can devitalize with APC.
- The integrated safety filter in the FiAPC probe prevents cross-contamination of the device and probe.
- You can apply APC axially and tangentially.
The pulmonology workstation
Combining cryotechnology with ESU and APC in a single workstation allows you to facilitate multiple application in bronchoscopy and interventional pulmonology.
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