Bronchoscopic Therapy Research Articles

The efficacy and safety of bronchial thermoplasty in severe persistent asthma on extended follow-up.

Asthma is a common condition and there remains a subset of patients who are poorly controlled on maximal therapy. Bronchial thermoplasty (BT) is a bronchoscopic therapy using radiofrequency energy to reduce airway smooth muscle, which has been shown to improve asthma control although further evidence regarding long-term efficacy and safety is required. We aimed to demonstrate safety and efficacy of BT on extended follow-up. Our initial experience with this group was previously reported in 2016, where patients were shown to have a significant improvement in asthma control test (ACT) scores 1-year post-treatment. We carried out a retrospective observational study of seven patients who underwent BT between 2012 and 2013 in an Irish severe asthma centre. The primary endpoint was change in ACT scores from baseline to present. Seven patients underwent BT at a tertiary referral centre in Ireland. ACT scores and data on hospital admissions, exacerbations, maintenance corticosteroid requirements, rescue bronchodilator use and forced expiratory volume for 1 s (FEV1) prior to the procedure and on extended follow-up were collected. Mean follow-up was 49.42 months. A trend towards improvement was seen in median hospitalisations (respective values for median over 12 months 3, 1 P = 0.059) and ACT scores, from 9 to 13 (P = 0.249). Mean FEV1 was 1.68 l prior to treatment and 1.46 l 4 years post-treatment (P = 0.237). There was no mortality among the group. These data support the safety of BT and suggest extended efficacy.

Interventional Bronchoscopic Therapy in Adult Patients with Tracheobronchial Mucoepidermoid Carcinoma.

Background:Tracheobronchial mucoepidermoid carcinoma (MEC) is a rare airway tumor in adults for which surgery is considered a first-line treatment. However, some patients already lost the best opportunity of a surgical intervention when diagnoses are confirmed, and surgery causes considerable trauma resulting in partial loss of pulmonary function. Moreover, the tumor is resistant to radiotherapy and chemotherapy. These factors make the treatment of tracheobronchial MEC challenging. This study aimed to evaluate the safety and efficacy of interventional bronchoscopic therapy in adult patients with tracheobronchial MEC.Methods:We retrospectively analyzed the clinical manifestations, bronchoscopic interventions, complications, and outcomes of 11 adult patients with tracheobronchial MEC. Paired t-test was used to analyze the parameters of the American Thoracic Society Dyspnea Index and the Karnofsky Score before and after the first interventional bronchoscopic therapy.Results:All tumors occurred in the main bronchus and were easily visualized by bronchoscopy. After interventional bronchoscopic therapy, the symptoms of all patients showed significant improvement. The American Thoracic Society Dyspnea Index decreased from 1.91 ± 1.22 to 0.27 ± 0.47 (t = 6.708, P < 0.001) and the Karnofsky Score increased from 78.18 ± 16.62 to 95.46 ± 8.20 (t = −5.190, P < 0.001). Bronchoscopic intervention did not result in serious complications or mortality. During the follow-up period between 3 and 96 months after the first therapy, the following results were noted: (1) among the eight patients with low-grade tracheobronchial MEC, only one patient had a relapse and agreed to surgical treatment; (2) among the three patients with high-grade tracheobronchial MEC, one patient required repeated bronchoscopic interventions, one patient died of pulmonary infection, and one patient died of systemic failure owing to tumor metastasis.Conclusions:Interventional bronchoscopic therapy, as an alternative treatment, shows promise in some adult patients with low-grade tracheobronchial MEC confined to the bronchus. However, for adult patients with high-grade tracheobronchial MEC, early diagnosis and surgical treatment are still strongly recommended.

Interventional pulmonology in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) and emphysema are widespread diseases associated with progressive dyspnea because of airflow limitation and hyperinflation. Fundamental therapeutic strategies consist of pulmonary rehabilitation, pharmacotherapy, long-term oxygen therapy, noninvasive ventilation, and surgical therapeutic approaches. In the last 14 years, endoscopic therapeutic modalities emerged as a substantial part of severe COPD and emphysema treatment. Techniques of the endoscopic lung volume reduction (ELVR) aim at reduction of hyperinflation. Thereby, the reversible valve implantation of which the efficacy was confirmed in various randomized controlled trials (RCT) results in lobar volume reduction and clinical benefit in emphysema patients with absent interlobar collateral ventilation. Nonblocking ELVR methods that are independent of collateral ventilation include the partially irreversible coil implantation leading to parenchymal compression, the irreversible bronchoscopic thermal vapor ablation and polymeric lung volume reduction both inducing inflammatory reaction. The nonblocking methods have been examined in only a few RCTs. The targeted lung denervation as a novel bronchoscopic therapy for COPD patients aims at sustainable bronchodilation by ablation of parasympathetic pulmonary nerves. The review summarizes the various endoscopic treatment approaches for managment of COPD and emphysema, their mechanism of action, their complications and the current available results of the most important RCTs.

Haemoptysis : Intensive care management of pulmonary hemorrhage

There is awide spectrum of severities in patients with pulmonary bleeding with arange from mild haemoptysis to severe bleeding with an acute risk of asphyxiation. For the management of acute pulmonary haemorrhage, it is essential to identify the underlying cause in order to initiate atarget-oriented or causal therapy. The most common causes of localized pulmonary bleeding are lung cancer as well as infections, anticoagulant therapy or bronchiectasis. Diffuse alveolar haemorrhage is mostly due to pulmonary vasculitis or connective tissue disease, but may also occur in pulmonary metastasis, congestive heart failure, coagulation disorders and from many other causes. In acase of severe pulmonary bleeding it is essential to secure the airways and ensure sufficient ventilation, i. e. by intubation with adouble-lumen endotracheal tube and by appropriate positioning of the patient. Stabilizing haemodynamics is crucial. Simultaneously basic diagnostic measures, i. e. appropriate laboratory tests, chest X‑ray, computed tomography scan of the chest and bronchoscopy, are performed. Localized pulmonary bleeding usually requires local treatment, like bronchoscopic therapy, bronchial artery embolization or surgery. Diffuse alveolar haemorrhage must be treated systemically, i. e. by immunosuppressive therapy in cases of vasculitis or by medical treatment of coagulation disorders. Even with optimal interdisciplinary management the in-hospital mortality of severe pulmonary bleeding remains high. There is asignificant risk of recurrent bleeding depending on the cause of haemorrhage. In patients with "cryptogenic" haemoptysis there is an increased rate of lung cancer within the following years and follow-up of these patients is recommended.

血管塞栓用コイルと外科用接着剤, n-ブチル-2-シアノアクリレート併用による, 気管支鏡下気管支断端瘻閉鎖法の経験

血管塞栓用コイルと外科用接着剤, n-ブチル-2-シアノアクリレート併用による, 気管支鏡下気管支断端瘻閉鎖法の経験

Therapy of Metastatic Non-small Cell Lung Cancer

Lung cancer accounts for the leading cause of cancer deaths in Germany and is characterized by early metastasis formation. The majority of patients with non-small cell lung cancer (NSCLC) will receive systemic therapy for treatment of their disease. Importantly together with the identification of targetable oncogenic alterations, systemic treatment of NSCLC has dramatically changed in recent years with the implementation of various new agents such as tyrosine kinase inhibitors, anti angiogenic agents, and immune modulating drugs. However, these new therapeutic options also challenge the treating physician since molecular, histologic, and clinical factors need to be considered for the clinical decision-making. Moreover, supportive therapy including bronchoscopic therapy has evolved. The following therapy recommendations will summarize the up-to date treatment strategies for metastatic NSCLC.

Management of Tracheo- or Bronchoesophageal Fistula After Ivor-Lewis Esophagectomy.

The development of tracheo- or bronchoesophageal fistula (TBF) after Ivor-Lewis esophagectomy remains to be a rare complication associated with a high mortality rate. In this retrospective study, the charts of patients with TBF after esophagectomy were analyzed in terms of individual patient characteristics, esophagotracheal complications, respiratory function, management, and outcome. Between January 2000 and December 2014, 1204 patients underwent Ivor-Lewis esophagectomy for esophageal cancer; 13 patients (1.1%) developed a TBF. In all 13 patients, a concomitant leakage of the intrathoracic esophagogastrostomy was evident, either prior to diagnosis of TBF (metachronous TBF) or simultaneously (synchronous TBF). TBF was predominantly located in the left main bronchus (n=6, 46.1%) or trachea (n=5, 38.5%). Management of TBF included re-thoracotomy (n=7), interventional endoscopic (n=10) or bronchoscopic therapy (n=4). In the majority of patients (n=8), management consisted of two subsequent treatment modalities. In 3 out of four patients, TBF was successfully treated by endoscopic stenting only. Five patients (38.5%) died following a septic course with multiple organ failure. The development of TBF after Ivor-Lewis esophagectomy is always combined with anastomotic leakage of the esophagogastrostomy. Treatment options primarily depend on the vascularization of the gastric conduit, the severity of the concomitant aspiration pneumonia, and the volume of the air leakage.

Treatment of Bronchopleural Fistula with Carbolic Acid instilled through Bronchofiberscope in post-pulmonectomy patients.

ObjectiveTo investigate the efficacy of carbolic acid treatment of bronchopleural fistula (BPF) using bronchofiberscope (BFS) in post-pulmonectomy patients.MethodTwelve patients with post-pulmonectomy BPF were enrolled in this study at the Liaoning Tumor Hospital between February 2009 and March 2012. Three patients had BPF after the right pneumonectomy, six patients after left pneumonectomy, one patient after the right middle and low lobectomy and two patients after left upper lobectomy. BPF patients were instilled with 100 % carbolic acid (0.5–1 ml one time every week) through BFS on the mucosal surface around the fistula, and the bubble disappearance was monitored. Treatment was repeated if the bubble remained.ResultsNo haemorrhage, severe dyspnea or SpO2 declines occurred in all the 12 patients during the bronchoscopic therapy. BPF orifices were closed in five patients after receiving 5 treatments with carbolic acid, 1 patient received 2 treatments, 1 patient was given 3 treatments, 2 patients received 4 treatments and 3 patients were given 7 treatments. Follow-up was conducted for six months following bronchoscopy. The average treatment and fistula closure time were calculated from the data collected as 20 min and 30 days, respectively, and the cure rate was 100 %. Hematoxylin-eosin (HE) staining results revealed that the white flat hyperplasia tissue after carbolic acid treatment was inflammatory granulation tissue.ConclusionOur results revealed that instillation of 100 % carbolic acid with BFS to treat BPF was 100 % effective, which can be a support for post-pulmonectomy BPF.

Clinical outcomes of photodynamic therapy in patients with central lung carcinoma in situ

Background: Bronchoscopic photodynamic therapy (PDT) is a treatment option for patients with early central lung cancer, especially ineligible for surgical resection. This study aimed to assess the clinical outcomes of curative PDT for patients with central lung carcinoma in situ (CIS). Methods: Five patients with central lung squamous CIS treated by PDT were analyzed. The PDT protocol was as followings: (1) intravenous photosensitizer (Photofrin for 1 patient or Photogem for 4 patients) 2mg/kg followed by bronchoscopic illumination 40–50h later using 630nm laser light, (2) the light dose of 100–200 J/cm with 2 cm length cylindrical type diffuser. Results: The patientswere allmalewithmedian age 70 (67–77). Five patients had each a squamous carcinoma in situ (Tis). Four lesions were synchronously detected with another main primary lung cancer (pathologic stage IA–IB). OneTiswas incidentally found during work-up for segmental lung atelectasis without other primary lung cancer. The rate of complete remission was 100% and median disease free survival (DFS) of PDT site was 74.0 months. There was no serious adverse event related to PDT. Median overall survival was not reached. 4-Year survival rate was 60%. Conclusion: PDT for central lung squamous CIS can achieve acceptable DFS and overall survival.

Irradiance measurements during treatment of actinic keratosis of the scalp with conventional photodynamic therapy

Background: Bronchoscopic photodynamic therapy (PDT) is a treatment option for patients with early central lung cancer, especially ineligible for surgical resection. This study aimed to assess the clinical outcomes of curative PDT for patients with central lung carcinoma in situ (CIS). Methods: Five patients with central lung squamous CIS treated by PDT were analyzed. The PDT protocol was as followings: (1) intravenous photosensitizer (Photofrin for 1 patient or Photogem for 4 patients) 2mg/kg followed by bronchoscopic illumination 40–50h later using 630nm laser light, (2) the light dose of 100–200 J/cm with 2 cm length cylindrical type diffuser. Results: The patientswere allmalewithmedian age 70 (67–77). Five patients had each a squamous carcinoma in situ (Tis). Four lesions were synchronously detected with another main primary lung cancer (pathologic stage IA–IB). OneTiswas incidentally found during work-up for segmental lung atelectasis without other primary lung cancer. The rate of complete remission was 100% and median disease free survival (DFS) of PDT site was 74.0 months. There was no serious adverse event related to PDT. Median overall survival was not reached. 4-Year survival rate was 60%. Conclusion: PDT for central lung squamous CIS can achieve acceptable DFS and overall survival.

Long-term follow-up after first-line bronchoscopic therapy in patients with bronchial carcinoids

BackgroundCarcinoid of the lung is considered to be a low-grade malignancy. A subgroup presents as an endobronchial tumour. Surgical resection is considered the standard approach because of its metastatic potential...

Targeted lung denervation for moderate to severe COPD: a pilot study

BackgroundParasympathetic pulmonary nerves release acetylcholine that induces smooth muscle constriction. Disruption of parasympathetic pulmonary nerves improves lung function and COPD symptoms.AimsTo evaluate ‘targeted lung denervation’ (TLD), a novel bronchoscopic therapy...

Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C

Tracheal stenosis is an uncommon but known complication of endotracheal intubation and tracheostomy. Surgery is currently the definitive treatment for tracheal stenosis but carries a significantly higher risk for adverse events as it often involves complex procedures. Here we present our experience using topical application of mitomycin C, along with various bronchoscopic interventions, as a treatment for tracheal stenosis. The patients in our series developed tracheal stenosis post-intubation or post-tracheostomy. Each patient in our series underwent the same basic procedures involving rigid bronchoscopy and balloon dilation, ablation of granulation tissue with cryotherapy and argon plasma coagulation, and finally application of topical mitomycin C. Our experience with these four cases shows a good initial success rate with topical mitomycin C application for the treatment of tracheal stenosis. Most patients required a repeat intervention a few weeks later. Our results suggest that success with topical mitomycin C is more likely in post-intubation rather than post-tracheostomy tracheal stenosis. Bronchoscopic therapy and topical application of mitomycin C may work better as a bridge to definitive surgery rather than as a stand-alone therapy.

Diagnostic and management effect of bronchoscopy on mycoplasma pneumonia with pulmonary atelectasis in children

Objective To explore the clinical characteristics of mycoplasma pneumonia with pulmonary atelectasis and lavage interventional effect through fiberoptic bronchoscopy in children. Methods During Jun 2012 to Apr 2013, fifty-three children diagnosed of mycoplasma pneumonia with pulmonary atelectasis who received fiberoptic bronchoscopy were enrolled as the experimental group. Thirty-five children diagnosed of mycoplasma pneumonia without pulmonary atelectasis were chosen as control group. According to the lavage interventional time of fiberoptic bronchoscopy, we divided the patients in the experimental group into two groups, the early group and late group. Clinical data and laboratory finds were collected and analyzed. Results The duration of fever, hospital stay and C-reactive protein (CRP) of the experimental group were significantly higher than those of the control group (P< 0.05). The location of pulmonary atelectasis in the experimental group were usually in the right middle lobe (18 cases, 33.9%). Under fiberoptic bronchoscope, all patients had obviously bronchial mucosa congestive edema. Some of them had follicular hyperplasia (9 cases, 17.0%), mucosal erosion (3 cases, 5.7%), mucus plug formation (7 cases, 13.2%) and poor ventilation of segmental bronchi (4 cases, 7.5%). Neutrophils (43 cases, 81.1%) increased and phagocytic cells (31 cases, 58.5%) dereased obviously in bronchoalevolar lavage fluid. After treatment in the experimental group, 52 children (98.1%) got complete recruitment of atelectasis. The average duration of fever and hospital stay of the early group were significantly shoter than those of late group (P< 0.05). Conclusion Children diagnosed of mycoplasma pneumonia with pulmonary atelectasis had longer fever duration and higher CRP level. Bronchoscopic interventional therapy promoted the recovery of pulmonary atelectasis. Using bronchoscop early in shorten the duration of fever and hospitalization in children diagnosed of mycoplasm pneumonia with pulmonary atelectasis. Key words: Children; Mycoplasma pneumoniae; Atelectasis; Fiberoptic bronchoscopy

A Case of Giant Bulla Successfully Treated by Bronchoscopic Lung Volume Reduction Therapy

A Case of Giant Bulla Successfully Treated by Bronchoscopic Lung Volume Reduction Therapy

Bronchial Thermoplasty Benefits Are Sustained for 5 Years

Bronchial thermoplasty is a bronchoscopic therapy for asthma in which controlled thermal energy is delivered to the airway wall during a series of

Clinical analysis of primary tracheobronchial amyloidosis

Objective To discuss the clinical features,diagnosis,treatment and prognosis of primary tracheobronchial amyloidosis.Methods We retrospectively studied 50 primary tracheobronchial amyloidosis cases reported in Chinese literature during 1989-2012 and one in our hospital.The clinical information,symptoms,imaging findings,endoscopic manifestations and treatment were analyzed.Results The patient in our hospital was admitted due to "short breath".Chest CT,bronchoscopy and pulmonary function examination were done;bronchoscopy biopsy specimen confirmed the diagnosis of PTA;and the patients responded to cyclophosphamide treatment.The main clinical symptoms of the 50 patients included cough(96%,48/50),short breath(70%,35/50),sputum(66%,33/50),fever(24%,12/50),and hemoptysis(22%,11/50).Thickening of lung markings(45.5%,15/33)was the most common chest X-ray finding;airway wall thickening and stenosis(76.2%,32/42) was the most common CT manifestation;and the most common endoscopic finding was also airway wall thickening and stenosis(40.8%,20/49),followed by mucosal congestion and edema(32.7%,16/49).Obstructive ventilatory dysfunction was found to be the major problem during pulmonary function tests.The diagnoses in 47(94%) patients were confirmed by bronchoscopic biopsy.Twenty-one literatures reported complications in 3 cases and misdiagnosis in 24 cases.Forty-two of the 50 patients received drug treatment,bronchoscopic interventional therapy,external beam radiation therapy and surgical treatment,and they responded well. Conclusion Primary tracheobronchial amyloidosis is rare and is prone to be misdiagnosed.Correct diagnose needs pathological examination and currently there is no specific treatment for it.

Bronchoscopic interventional therapy in airway stenosis

Because bronchoscopy and CT technology development,the number of confirmed cases of children with airway stenosis have increased every year,but clinical management of pediatric airway constriction is a very thorny issue.This article described the application principles,indications and methods of thermal cauterization,cryotherapy,balloon dilatation airway-plasty and airway stent in airway stenosis. Key words: Bronchoscopy; Interventional therapy; Airway stenosis; Children

Outcome of endobronchial electrocautery versus external beam radiotherapy or both together in the palliative management of non-small cell lung cancer

BackgroundApproximately 75% of patients with non-small cell lung cancer (NSCLC) present with locally advanced or metastatic disease which renders them inoperable and virtually incurable. Whene the aim of treatment is palliation, radiotherapy and bronchotherapeutic procedures are often recommended. Aim of the workTo evaluate the outcome of endobronchial electrocautery and or external beam radiotherapy (XRT) in the palliative treatment of patients with inoperable non-small cell lung cancer. Patient and methods40 patients with unresectable stage IIIA and IIIB NSCLC, 33 males and 7 females, their mean age of 60.82±6.23years were recruited in the study. Eligible patients were randomly classified into 3 groups: Group I: included 11 patients who received combined external irradiation (XRT) with end bronchial electro cautery, Group II: included 11 patients who received end bronchial electrocautery without external irradiation XRT, Group III: including 18 patients who received external palliative irradiation alone. Evaluation of chest symptoms, chest CT, PFTs, ABGs and quality of life outcomes were done before the interventional bronchoscopy and XRT therapies then one week and one month after the end of treatment. ResultsAs regards improvement of endobronchial symptoms; one week after completion of treatment, Group III patients was significantly lesser than Groups I and II and one month after treatment, there was no significant difference between all patient groups except in cough which was in Group III of lesser improvement than Groups I and II. As regards patients who had atelectasis before starting treatment: Group I showed 100% disappearance of atelectasis either complete or partial one month after completion of treatment while Group II showed 77.77% disappearance of atelectasis either complete or partial and finally Group III showed 64.29% disappearance of atelectasis either complete or partial. As regards changes in both FEV1% and FVC%; all patient groups showed significant differences pretreatment and one month after completion of treatment and Group I patients was significantly different than patients of both Groups II & III. ConclusionsThe replacement of external radiation with bronchoscopic therapy may not be a recommended option, but its addition to XRT may be a relatively simple method of augmenting the symptom palliative effect, providing higher response rates for re-expansion of collapsed lung and reducing endobronchial obstruction endoscopically.

気管支鏡下半導体レーザー治療にて治療し得た外傷後瘢痕性気道狭窄の1例

43歳，男性．胸部鈍的外傷による気管・気管支損傷に対し，保存的に経過観察されたが，遅発的に気道狭窄をきたしたため，治療目的に当科転院となった．気管分岐部から右主気管支に高度の瘢痕性狭窄を認め，当初，気管支鏡下に半導体レーザー併用しバルーン拡張術を繰り返すも十分な気道の開大，症状の改善を認めなかった．受傷後の気道狭窄機転を考察し気管膜様部と右主気管支前壁との瘢痕性癒着をはがすように半導体レーザーを焼灼したところ瘢痕性癒着がはがれ気道の開大が得られた．直後より自覚症状の著明な改善が得られた．治療後4年経過するも狭窄症状は認めていない．