Low bleeding rates following transbronchial lung cryobiopsy in unclassifiable interstitial lung disease

Abstract

Background and ObjectiveBronchoscopic transbronchial lung cryobiopsy (TBLC) is a guideline‐endorsed alternative to surgical lung biopsy for tissue diagnosis in unclassifiable interstitial lung disease (ILD). The reported incidence of post‐procedural bleeding has varied widely. We aimed to characterize the incidence, severity and risk factors for clinically significant bleeding following TBLC using an expert‐consensus airway bleeding scale, in addition to other complications and diagnostic yield.MethodsA retrospective cohort study of consecutive adult outpatients with unclassifiable ILD who underwent TBLC following multidisciplinary discussion at a single centre in the UK between July 2016 and December 2021. TBLC was performed under general anaesthesia with fluoroscopic guidance and a prophylactic endobronchial balloon.ResultsOne hundred twenty‐six patients underwent TBLC (68.3% male; mean age 62.7 years; FVC 86.2%; DLCO 54.5%). Significant bleeding requiring balloon blocker reinflation for >20 min, admission to ICU, packed red blood cell transfusion, bronchial artery embolization, resuscitation or procedural abandonment, occurred in 10 cases (7.9%). Significant bleeding was associated with traction bronchiectasis on HRCT (OR 7.1, CI 1.1–59.1, p = 0.042), a TBLC histological pattern of UIP (OR 4.0, CI 1.1–14, p = 0.046) and the presence of medium‐large vessels on histology (OR 37.3, CI 6.5–212, p < 0.001). BMI ≥30 (p = 0.017) and traction bronchiectasis on HRCT (p = 0.025) were significant multivariate predictors of longer total bleeding time (p = 0.017). Pneumothorax occurred in nine cases (7.1%) and the 30‐day mortality was 0%. Diagnostic yield was 80.6%.ConclusionTBLC has an acceptable safety profile in experienced hands. Radiological traction bronchiectasis and obesity increase the risk of significant bleeding following TBLC.