Spray Cryotherapy for the Treatment of Benign Airway Obstruction: Case Series

Abstract

SESSION TITLE: Procedures 1 - EMN/BT/Rigid/Cryo SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: The management of benign airway obstruction poses a challenge since currently available bronchoscopic approaches showed inconsistent outcomes and were prone to complications and early failure. Spray cryotherapy (SCT) is a relatively new device that uses non contact thermal energy with an adjustable flow to deliver liquid nitrogen at a slower rate in the airways. SCT allows for re-growth of normal epithelium with minimal scarring and may improve healing response. We describe our initial experience in applying SCT for the treatment of benign airway obstruction. METHODS: This was a retrospective case series of 5 patients (4 women and 1 man) who underwent SCT. Median age was 42 (33-80) years. Prior therapy had been undertaken in 4/5 (80%) of patients. Stricture etiology included granulomatosis with polyangitis (n = 1), radiation induced (n = 1) and unknown etiology (n = 3). Three patients had complex stenosis (>1cm) and 2 had simple stenosis (≤ 1cm). The usual treatment algorithm consisted of 3 SCT cycles followed by intralesional steroids injection, balloon dilation and mechanical debridement and electrocautery (as necessary). RESULTS: Four patients had subglottic stenosis and 1 had mid-tracheal stenosis. Presenting symptoms were dyspnea 100% (5/5), cough in 80% (4/5), recurrent infection 40 % (2/5) and stridor 40% (2/5). At a median follow up of 40 days; dyspnea, cough and stridor improved in 60 % (3/5), 50% (2/4) and 50% (1/2) respectively. Overall, there was an improvement of mMRC (modified medical research council) score and FEV1 from 2.5 and 2.09 L to1 and 2.57 L post therapy. Only one transient desaturation occurred that resolved spontaneously. Two patients required subsequent interventions along with stent placement due to recurrence of stenosis and symptoms. CONCLUSIONS: Our initial experience of SCT combined with other endoscopic modalities suggests that it is a promising and effective therapeutic approach for benign airway obstruction in improving symptoms and quality of life. However, re-intervention might still be required. Larger studies are needed to confirm safety and efficacy of SCT in combination with other treatment modalities. CLINICAL IMPLICATIONS: SCT appears to be safe and improved respiratory symptoms in this small case series but further studies are needed to assess long term efficacy, time to re-intervention and adverse events in patients with benign airway obstruction. DISCLOSURE: The following authors have nothing to disclose: Fayez Kheir, Daniel Alape, Erik Folch, Sebastian Fernandez-Bussy, Alejandro Folch, Adnan Majid No Product/Research Disclosure Information