Skip to main content

Sequential use of cryoextraction postelectrocautery for airway recanalization using fiberoptic bronchoscopy

Abstract

Background

Airway obstruction presents with dyspnea, cough, hemoptysis, and atelectasis. Removing or decreasing the size of the obstructing lesions improves patient’s symptoms and life quality.

Aim

Assessing the efficacy and safety of sequential use of cryoextraction and electrocautery in achievement of airway patency using fiberoptic bronchoscopy (FOB).

Patients and methods

This study was conducted at the Chest Medicine Department, Mansoura University, Egypt and included 22 patients with central airway obstruction (15 males and seven females) with a mean age of 50.5 ± 18.3 years. After etiologic diagnosis of airway obstruction, they were divided into two groups: group A (nonmalignant); eight patients and group B (malignant); 14 patients. All patients were subjected to sequential use of cryoextraction after electrocautery. Operable, unfit patients or patients with extraluminal obstruction were excluded. Clinical, radiological, functional, and bronchoscopic data were evaluated before and after FOB.

Results

The improvement in performance scale was highly significant in group B (P < 0.001) and significant in group A (P = 0.001). Spirometric parameters improved in both groups but were highly significant in group B (P < 0.001). Radiological improvement occurred in four out of eight of group A and in three out of 14 of group B. FOB score improved in group B (P = 0.003) and was more significant in group A. The procedure was complicated with atrial fibrillation and hemoptysis in one case and postbronchoscopy hypoxemia in two cases with no deaths.

Conclusion

Cryoextraction after electrocautery using FOB are effective, safe, easy, and cheap in achieving airway patency. Egypt J Broncho 2015 9:269–275

References

  1. Lee P, Tamm M, Chhajed PN. Advances in bronchoscopy –therapeutic bronchoscopy. J Assoc Physicians India 2004; 52:905–914.

    PubMed  Google Scholar 

  2. Kupeli E, Karnak D, Mehta AC. Flexible bronchoscopy. In: Mason RJ, Murray JF, Broaddus VC, Nadel JA, Martin RT, King TE, Talmadge E, Schraufnagel DE, editors. Murray and Nadel’s textbook of respiratory medicine. 5th ed. USA: Elsevier; 2010. –331.

    Google Scholar 

  3. Lahm T, Sheksi FD. Update on cryotherapy, brachytherapy, and photodynamic therapy. In: Mathur P, Mehta AC, Beamis J, editors. Interventional pulmonary medicine. 5th ed. USA: Informa Healthcare; 2010. 230:–44.

    Google Scholar 

  4. Altin S, Dalar L, Karasulu L, Cetinkaya E, Timur S, Solmazer N. Resection of giant endobronchial hamartoma by electrocautery and cryotherapy via flexible bronchoscopy. Tuberk Toraks 2007; 55:390–394.

    PubMed  Google Scholar 

  5. Koletsis EN, Prokakis C, Karanikolas M, Apostolakis E, Dougenis D. Current role of surgery in small cell lung carcinoma. J Cardiothorac Surg 2009; 4:30–34.

    Article  Google Scholar 

  6. American Thoracic Society. Dyspnea: mechanisms, assessment and management a consensus statement. Am J Respir Crit Care Med 1999; 159:321–340.

    Article  Google Scholar 

  7. Walsh DA, Maiwand MO, Nath AR, Lockwood P, Lloyd MH, Saab M. Bronchoscopic cryotherapy for advanced bronchial carcinoma. Thorax 1990; 45:509–513.

    Article  CAS  Google Scholar 

  8. Speiser B, Spratling L. Remote after loading brachytherapy for the local control of endobronchial carcinoma. Int J Radiat Oncol Biol Phys 1993; 25:57–67.

    Google Scholar 

  9. Muers MF. Quality of life and symptom control. Eur Respir Monogr 2001; 17:305–329.

    Google Scholar 

  10. Gridelli C, Ardizzoni A, Le Chevalier T, Manegold C, Perrone F, Thatcher N, et al. Treatment of advanced non-small-cell lung cancer patients with ECOG performance status 2: results of an European Experts Panel. Ann Oncol 2004;15:419–426.

    Article  CAS  Google Scholar 

  11. Speiser B. Protocol for local control of endobronchial carcinoma using remote after loading HDR brachytherapy. Act Sel Brachyther J 1990; 1:16–19.

    Google Scholar 

  12. Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R. New response evaluation criteria in solid tumors: revised RECIST guideline. Eur J Cancer 2009; 45:228–247.

    Article  CAS  Google Scholar 

  13. Seaman JC, Musani AI. Endobronchial ablative therapies. Clin Chest Med 2013; 34:417–425.

    Article  Google Scholar 

  14. Sutedja G, Postmus PE. Bronchoscopic treatment of lung tumors. Lung Cancer 1994; 11:1–17.

    Article  CAS  Google Scholar 

  15. Homasson JP. Endobronchial electrocautery. Semin Respir Crit Care Med 1997; 18:535–543.

    Article  Google Scholar 

  16. Mohammad YA. Evaluation of the role of APC and cryotherapy in management of endobronchial tumors MD thesis]. Egypt: Chest Department, Faculty of Medicine, Assiut University; 2007

    Google Scholar 

  17. AbdelSalam N. Argon plasma coagulation versus chemotherapy in palliative treatment of inoperable non-small cell lung cancer MD Thesis]. Egypt: Chest Department, Faculty of Medicine, Mansoura University; 2005

    Google Scholar 

  18. Asimakopoulos G, Beeson J, Evans J, Maiwand MO. Cryosurgery for malignant endobronchial tumors: analysis of outcome. Chest 2005; 127:–2014.

  19. Maiwand MO. Endobronchial cryosurgery. Chest Surg Clin N Am 2001; 11:791–811.

    PubMed  CAS  Google Scholar 

  20. Maiwand MO, Asimakopoulos G. Cryosurgery for lung cancer: clinical results and technical aspects. Technol Cancer Res Treat 2004; 3:143–150.

    Article  CAS  Google Scholar 

  21. Hussein RM, Korraa EA, Fawzy MA, Sileem AE. Prognostic factors for bronchoscopic electrocautery and/or argon plasma coagulation in patients with central airway obstruction. Egypt J Chest Dis Tuberculosis 2013; 62:501–511.

    Article  Google Scholar 

  22. Amer WM, Kamel KM, El-Shahat HM, Nafea RM. Role of electrocautery and argon plasma coagulation in management of endobronchial neoplasms. Zagazig Univ Med J 2012; 18:80–86.

    Google Scholar 

  23. Sutedja G, van Kralingen K, Schramel F, Postmus PE. Fiberoptic bronchoscopic electrosurgery under local anaesthesia for rapid palliation in patients with central airway malignancies: a preliminary report. Thorax 1994; 49:1243–1246.

    Article  CAS  Google Scholar 

  24. Ledingham SJ, Goldstraw P. Diathermy resection and radioactive gold grains for palliation of obstruction due to recurrence of bronchial carcinoma after external irradiation. Thorax 1989; 44:48–51.

    Article  CAS  Google Scholar 

  25. Safwat T, Hosny M, Korraa M, Madkour A, Elghazaly H, Ali T. The efficacy of bronchoscopic intratumoral chemotherapy in palliation of inoperable lung cancer: initial Egyptian experience. Egypt J Bronchol 2011; 5:96–104.

    Google Scholar 

  26. Sindhwani G, Rawat J, Keserwani V. Role of endobronchial electrocautery in management of neoplastic central airway obstruction: initial experience with seven cases. Indian J Chest Dis Allied Sci 2012; 54:165–168.

    PubMed  Google Scholar 

  27. Hetzel M, Hetzel J, Schumann C, Marx N, Babiak A. Cryorecanalization: a new approach for the immediate management of acute airway obstruction. J Thorac Cardiovasc Surg 2004; 127:1427–1431.

    Article  Google Scholar 

  28. Coulter TD, Mehta AC. The heat is on: impact of endobronchial electrosurgery on the need for Nd-YAG laser photoresection. Chest 2000; 118:516–521.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Asem A. Hewidy MD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

El Badrawy, M.K., Shalabi, N.M., Hewidy, A.A. et al. Sequential use of cryoextraction postelectrocautery for airway recanalization using fiberoptic bronchoscopy. Egypt J Bronchol 9, 269–275 (2015). https://doi.org/10.4103/1687-8426.165920

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1687-8426.165920

Keywords

  • cryoextraction
  • electrocautery
  • lung cancer