Transbronchial lung biopsy with a flexible cryoprobe during rigid bronchoscopy: Standardizing the procedure

Cryoprobe transbronchial lung biopsy with flexible bronchoscope using Arndt endobronchial blocker

“…Studies have reported major bleeding with flexible bronchoscopic cryoprobe TBLB performed without the use of a bronchial blocker. [ 3 ] Alternatively, there are also descriptions of the use of a rigid bronchoscope to provide a secured airway during the procedure without the use of a occlusion balloon. [ 3 ] However, in our opinion, the use of an occlusion balloon is essential during cryoprobe TBLB.…”

“…[ 3 ] Alternatively, there are also descriptions of the use of a rigid bronchoscope to provide a secured airway during the procedure without the use of a occlusion balloon. [ 3 ] However, in our opinion, the use of an occlusion balloon is essential during cryoprobe TBLB. In ideal settings and to maximize procedural safety, rigid bronchoscope as the ventilation conduit, use of an occlusion balloon-like Fogarty balloon catheter to provide tamponade following biopsy, and general anesthesia is preferable, and this allows for a controlled environment to perform the procedure.…”

“…[ 2 ] Exclusive use of a flexible bronchoscope may allow the performance of this procedure, but without the use of an occlusion balloon, this may be associated with unpredictable severe bleeding. [ 3 4 ] Some authors have reported the use of single flexible bronchoscope while others have used two flexible bronchoscopes in sequential manner or rendezvous method. [ 4 ] Artificial airway management options during the procedure include supraglottic airway, endotracheal tube, or rigid bronchoscope.…”

Cryoprobe transbronchial lung biopsy: How we do it?

“…[ 2 3 ] Excessive bleeding has been reported when performed using a flexible bronchoscope exclusively. [ 4 ] We recommend rigid bronchoscopy in all patients as the risk of airway bleeding, and possible airway loss is higher without rigid bronchoscopy. [ 4 ] Second, general anaesthesia enables apnea while taking biopsy that minimizes the risk of pneumothorax.…”

Rupture of occlusion balloon during transbronchial lung cryobiopsy

“…The most common complications during cryoprobe TBLB are bleeding and pneumothorax. [ 3 ] We have been performing biopsies using this technique for 2 years and did not encounter any significant bleeding complications though we have encountered pneumothorax and pneumomediastinum. [ 4 ] Recently, we encountered an unusual complication during TBLC.…”