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; RK Verma

doi:10.4103/lungindia.lungindia_220_20

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Official publication of Indian Chest Society

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ORIGINAL ARTICLE

Year : 2021 | Volume : 38 | Issue : 2 | Page : 109-116

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 Goel¹, Ajay Kumar¹, Gargi Maitra¹, Balkar Singh², Sunita Ahlawat³, Priti Jain³, Neeraj Garg³, RK Verma⁴
¹ Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Gurugram, Haryana, India
² Department of Anesthesiology, Fortis Memorial Research Institute, Gurugram, Haryana, India
³ Department of Pathology, Fortis Memorial Research Institute, Gurugram, Haryana, India
⁴ Department of Radiology, Fortis Memorial Research Institute, Gurugram, Haryana, India

Correspondence Address:
Dr. Manoj Kumar Goel
Department of Pulmonology, Critical Care and Sleep Medicine, Fortis Memorial Research Institute, Sector 44, Gurugram - 122 002, Haryana
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/lungindia.lungindia_220_20

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.

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