Safety and Performance Characteristics of Outpatient Medical Thoracoscopy and Indwelling Pleural Catheter Insertion for Evaluation and Diagnosis of Pleural Disease at a Tertiary Center in Canada

Abstract

Background Many centers performing medical thoracoscopy (MT) to diagnose pleural disease will insert a chest tube and admit patients to hospital after the procedure, which is inconvenient for patients and contributes to healthcare costs. We report the data on the safety, outcomes, and performance characteristics of outpatient MT with indwelling pleural catheter (IPC) insertion in a large Canadian cohort. Methods This retrospective cohort study reviewed patients who underwent outpatient MT and IPC insertion under conscious sedation. Patients without complications were discharged the same day. We report the data on safety, outcomes, and performance characteristics of our program. Results Outpatient MT and IPC insertion was performed on 218 patients. 99.1% of patients were safely discharged the same day. There was no procedure associated mortality. Pleural malignancy (59.6%) and nonspecific pleuritis (29.4%) were the most common pathologies. Pleural nodularity detected endoscopically was excellent at predicting malignancy with a positive predictive value of 92.5% and is more frequently detected endoscopically when compared to CT scan (p < 0.001). Conclusions In the setting of a comprehensive pleural disease program, outpatient MT can be safely performed and is an alternative to an inpatient surgical approach for undiagnosed pleural effusions.

Clinical predictors of successful and earlier pleurodesis with a tunnelled pleural catheter in malignant pleural effusion: a cohort study

“…Combined insertion of a tunnelled pleural catheter and medical thoracoscopy has been described and facilitates safe same-day discharge. 9,10 Medical thoracoscopy may also be combined with talc pleurodesis 11 if earlier pleurodesis is desired or if catheter removal is expected to be delayed. Combined outpatient medical thoracoscopy and insertion of a tunnelled pleural catheter should be strongly considered as the diagnostic and therapeutic approach for patients suspected to have malignant pleural effusion in whom the cytologic findings are nondiagnostic and for those in whom more tissue is required for ancillary testing.…”

Review of the Physiology and Anesthetic Considerations for Pleuroscopy/Medical Thoracoscopy

“…Despite several studies reporting on the safety of midazolam in pleuroscopy, none of them was designed to closely examine the safety and efficacy of PSA during the procedure. Rather, they concentrated more on the overall intervention-related outcomes, safety, and diagnostic outcomes [70][71][72][73][74].…”

Developments in Diagnostic and Interventional Procedures in Lung Cancer

“…Moreover, there is increasing evidence that talc pleurodesis through the indwelling pleural catheter may result in a higher pleurodesis rates of 43% compared to that of 23% observed in patients who had indwelling pleural catheter drainage of the fluid alone [35]. Similarly, there are reports to suggest that the insertion of an indwelling pleural catheter at the end of the thoracoscopy procedure is safe and may reduce the hospital length of stay [36].…”