Chest
Clinical InvestigationsBronchoscopic Cryotherapy for Airway Strictures Caused by Tumors
Section snippets
Material and Methods
The endoscopic treatment was carried out using a cryoprobe that employs the Joule-Thomson effect (cooling of a gas upon sudden expansion from a high to a low pressure region).
This cryoprobe, with interchangeable tips, measures 55 cm in length and 3 mm in outside diameter. The principal feature of the probe is to be nonrigid, thus enabling one to reach tumors obstructing the main bronchus of the upper lobe. The entire probe is insulated except for the distal 1 cm. The cryoprobe is introduced
Results
Palliation was the most favorable outcome that we expected to achieve (Table 1). For malignant tumors of the bronchial tree, our objective was obtained in 13 cases out of 21: disappearance or important regression of the tumor permitting renewed or improved ventilation of a lobe (Figure 2, Figure 3, Figure 4) or a lung and interruption of hemoptysis.
We also managed to ablate five small benign granulomas without complications. Nevertheless, we had five technical failures: in one case, the probe
Complications
Two patients had a mild fever the same evening, but this may occur after any bronchial endoscopy. During cryotherapy, all patients were monitored by an electrocardiogram. Three of them showed a change in rhythm during the examination, but not coinciding with the time of cooling. A tachycardia often appears during bronchial endoscopy but it is not necessary to make electrocardiographic monitoring mandatory for this examination. Nevertheless, ECG monitoring revealed the reason for the death of an
Discussion
Cryotherapy in the bronchial tree is capable of inducing coagulation necrosis of tissue and destruction of tumors. All patients in this series with tumoral lesions were at an advanced stage of their illness; the data of this study do not show that survival has been extended, but the quality of life has certainly been improved with new ventilation of a lung or lobes and the cessation of hemoptysis. Five patients are still alive six months after cryotherapy; seven died from brain metastasis.
The
References (10)
- et al.
Endotracheal cryotherapy in the treatment of refractory airway strictures
Ann Thorac Surg
(1983) - et al.
Cryosurgery of bronchopulmonary structures: an approach to lesions inacessible to the rigid bronchoscope
Chest
(1977) - et al.
Measurement of intratissue bioelectrical low frequency impedance: a new method to predict per operatively the destructive effect of cryosurgery
Cryobiology
(1977) On the treatment of cancer through the regulated application of an anaesthetic temperature
(1851)- et al.
Cryostatic congelation: a system for producing a limited controlled region of cooling or freezing of biological tissues
J New and Ment Dis
(1961)
Cited by (97)
Bronchoscopic management of malignant central airway obstructions
2023, Revue des Maladies RespiratoiresEndoscopic treatment of tracheal stenosis
2014, Thoracic Surgery ClinicsCitation Excerpt :As a precaution, a distance of 5 mm between the argon beam and the tumor should be maintained, as with a laser fiber. The third instrument that can accomplish tumor removal from central airway is the cryoprobe.10,11 Using the Joule-Thomson effect, a gas conducted from a tank through a catheter rapidly expands, causing extreme cold at the metal tip that is pressed against the tumor.
Tracheal Stenosis
2010, Medical Management of the Thoracic Surgery PatientBritish Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults
2011, ThoraxCitation Excerpt :Cryotherapy appears to be safe in the treatment of malignant endobronchial obstruction. In case series,57–63 the complications observed were haemoptysis (4–10%), bronchospasm (4.5%), cardiac arrhythmia (11%) and death (1.3%). One case series reported on cryoextraction for recanalisation (cryorecanalisation) with a 10% rate of significant bleeding (six patients) managed with conservative measures and APC; no deaths were reported in the series.64
Management of malignant central airway obstruction
2021, Shanghai Chest
Manuscript received May 1, 1985; revision accepted January 10.