Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

Ost, David; Ernst, Armin; Grosu, Horiana B.; Lei, Xiudong; Diaz-Mendoza, Javier; Slade, Mark; Gildea, Thomas R.; Machuzak, Michael; Jiménez, Carlos A.; Toth, Jennifer; Kovitz, Kevin L.; Ray, Cynthia; Greenhill, Sara; Casal, Roberto F.; Almeida, Francisco A.; Wahidi, Momen M.; Eapen, George A.; Yarmus, Lonny; Morice, Rodolfo C.; Benzaquen, Sadia; Tremblay, Alain; Simoff, Michael

doi:10.1378/chest.14-1530

Cited by 147 publications

(126 citation statements)

References 36 publications

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“…While there were no fatal procedural complications in this study, the overall rate of fatal procedural complications reported in AQuIRE was 0.5% 27. The overall risk-benefit ratio of therapeutic bronchoscopy is very favourable if we use 0.5% as our estimate of fatal procedural complications and consider ∆utility-long-term as roughly a 5.8% improvement over baseline.…”

Section: Discussionmentioning

confidence: 65%

Long-term quality-adjusted survival following therapeutic bronchoscopy for malignant central airway obstruction

Ong

Grosu

Debiane

et al. 2018

Thorax

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BackgroundWhile therapeutic bronchoscopy has been used to treat malignant central (CAO) airway obstruction for >25 years, there are no studies quantifying the impact of therapeutic bronchoscopy on long-term quality-adjusted survival.MethodsWe conducted a prospective observational study of consecutive patients undergoing therapeutic bronchoscopy for CAO. Patients had follow-up at 1 week and monthly thereafter until death. Outcomes included technical success (ie, relief of anatomic obstruction), dyspnoea, health-related quality of life (HRQOL) and quality-adjusted survival.ResultsTherapeutic bronchoscopy was performed on 102 patients with malignant CAO. Partial or complete technical success was achieved in 90% of patients. At 7 days postbronchoscopy, dyspnoea improved (mean ∆Borg-day-7=−1.8, 95% CI −2.2 to −1.3, p<0.0001) and HRQOL improved (median prebronchoscopy 0.618 utiles, 25%–75% IQR 0.569 to 0.699, mean ∆utility-day-7+0.047 utiles, 95% CI +0.023 to 0.071, p=0.0002). Improvements in dyspnoea and HRQOL were maintained long-term. Compared with the prebronchoscopy baseline, HRQOL per day of life postbronchoscopy improved (mean ∆utility-long-term+0.036 utiles, 95% CI +0.014 to 0.057, p=0.002). Median quality-adjusted survival was 109 quality-adjusted life-days (QALDs) (95% CI 74 to 201 QALDs). Factors associated with longer quality-adjusted survival included better functional status, treatment-naïve tumour, endobronchial disease, less dyspnoea, shorter time from diagnosis to bronchoscopy, absence of cardiac disease, bronchoscopic dilation and receiving chemotherapy.ConclusionsTherapeutic bronchoscopy improves HRQOL as compared with baseline, resulting in approximately a 5.8% improvement in HRQOL per day of life. The risk-benefit profile in these carefully selected patients was very favourable.Trial registration numberResults; NCT03326570.

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Section: Discussionmentioning

confidence: 65%

Long-term quality-adjusted survival following therapeutic bronchoscopy for malignant central airway obstruction

Ong

Grosu

Debiane

et al. 2018

Thorax

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“…They also found that the complication rate was higher in those with ASA >3, re-do bronchoscopy, receiving procedure under emergent or urgent situation. Thirty-day mortality was associated with poor performance status and ASA >3 (60). However, the patients with higher baseline Borg score had the greater improvement in dyspnea and quality of life.…”

Section: Developing Stentsmentioning

confidence: 94%

“…Interventional bronchoscopy provides a less invasive choice with high technical success rate (90-98%) and is effective for central airway obstruction to improve quality of life and survival (10,11,13). The complication is relative rare (3.9%) with few mortality (0.5%) (60). Nevertheless, the benefit is difficult to predict in patients under different situation.…”

Section: Developing Stentsmentioning

confidence: 99%

Central airway tumors: interventional bronchoscopy in diagnosis and management

Lin

Chung

2016

J. Thorac. Dis.

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The diagnosis of central airway tumors is usually challenging because of the vague presentations.Advances in visualization technology in bronchoscopy aid early detection of bronchial lesion. Cryotechnology has great impact on endobronchial lesion sampling and provides better diagnostic yield. Airway tumor involvements result in significant alteration in life quality and lead to poor life expectancy. Timely and efficiently use ablation techniques by heat or cold energy provide symptoms relief for central airway obstruction. Prostheses implantation is effective in maintaining airway patency after ablative procedure or external compression. Combined interventional bronchoscopy modalities and other adjunctive therapies have improvement in quality of life and further benefit in survival. This review aims to provide a diagnostic approach to central airway tumors and an overview of currently available techniques of interventional bronchoscopy in managing symptomatic central airway obstruction. Here, we provide a clinical review of interventional bronchoscopy in diagnoses and management of central airway tumors. Keywords Diagnostic modalities Computed tomographyOnly less than 30% patients with tracheal tumors have been diagnosed via chest radiography (14). Traditional CT scan is more sensitive and can provide information on the extent of airway lesions. Newly developed multidetector CT (MDCT) can accurately detect airway tumor locations, natures, quantities (1). The extra luminal anatomy is also clearly depicted. Thus, MDCT is a rapid and non-invasive method to provide comprehensive information about the extent of disease process before surgery or interventional bronchoscopy (1). Visualization of bronchoscopyBronchoscopy is the mainstay to approaching endobronchial lesion under direct vision. In addition to conventionally white light bronchoscopy, autofluorescence (AFB) and narrow band imaging (NBI) are new visualization techniques of bronchoscopy which can aid detection of bronchial mucosa lesions (15). Although the specificity of AFB is low and similar to white light bronchoscopy, there is no doubt in usefulness of detecting early bronchial mucosal lesion and evaluate the margin of mucosal involvement (16,17). NBI is designed to detect angiogenesis and neovascular lesion. The diagnostic accuracy is increased under NBI bronchoscopy (15). Both of them have superior sensitivity comparing with white light bronchoscopy [3][4][5]. Endobronchial ultrasonography (EBUS) is also helpful in evaluating the extent of airway lesion involvement (14,18). Tissue sampling: forceps versus cryotechnologyForceps biopsy under direct bronchoscopic vision is the most common method to obtain tissue sample from endobronchial lesion. However, the size of tissue sample is limited by the forceps size. Small samples with crush artifacts are probably insufficient for accurate diagnosis. The diagnostic yield is only 85% of conventional forceps biopsy and patients usually have to repeat bronchoscopy (2,3).Cryotechnology has been used as a t...

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“…It is well known that airway stenting sometimes causes complications, such as retained secretions, granulation tissue formation, and stent migration (18). Although reported complication rates vary widely among studies, serious complications rarely occur (18,19). The complications in the current study were managed easily and seem to be acceptable.…”

Section: Discussionmentioning

confidence: 53%

Airway stenting in patients requiring intubation due to malignant airway stenosis: a 10-year experience

Oki¹,

Sasaki²,

Hori³

2017

J. Thorac. Dis.

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Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction

Cited by 147 publications

References 36 publications

Long-term quality-adjusted survival following therapeutic bronchoscopy for malignant central airway obstruction

Long-term quality-adjusted survival following therapeutic bronchoscopy for malignant central airway obstruction

Central airway tumors: interventional bronchoscopy in diagnosis and management

Airway stenting in patients requiring intubation due to malignant airway stenosis: a 10-year experience

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