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Bleeding risk of transbronchial cryobiopsy compared to transbronchial forceps biopsy in interstitial lung disease - a
Juergen Hetzel1, Ralf Eberhardt2, Christoph Petermann3
1Department of Haematology, Oncology, Rheumatology, Immunology and Pulmology, Eberhard Karls University, Otfried-Mueller-Str. 10, 70771, Tübingen, Germany. juergen.hetzel@med.uni-tuebingen.de.
Insights
Transbronchial cryobiopsy for interstitial lung disease increases bleeding risk compared to forceps biopsy. Careful consideration of this higher bleeding complication rate is essential for patient safety.
Area of Science:
- Pulmonology
- Interventional Pulmonology
- Medical Devices
Background:
- Bronchoscopic cryobiopsy is an emerging technique for obtaining lung tissue samples in interstitial lung disease (ILD).
- While cryobiopsy yields high-quality tissue adequate for diagnosis, bleeding is a significant complication of transbronchial biopsies.
- This study investigates the bleeding risk associated with transbronchial cryobiopsy.
Purpose of the Study:
- To compare the risk of bleeding between transbronchial cryobiopsy and conventional transbronchial forceps biopsy in patients with ILD.
- To evaluate the severity and clinical relevance of bleeding complications associated with each biopsy method.
Main Methods:
- A prospective, randomized, controlled multicenter study included 359 patients with ILD requiring diagnostic bronchoscopic tissue sampling.
- Each patient underwent both transbronchial forceps biopsy and transbronchial cryobiopsy, with procedure sequence randomized.
- Bleeding severity was semi-quantitatively assessed as no bleeding, mild, moderate, or severe for each intervention.
Main Results:
- A total of 1160 cryobiopsies and 1302 forceps biopsies were performed.
- Bleeding occurred in 72.7% of cryobiopsy procedures versus 48.2% of forceps biopsies (p < 0.001).
- Clinically relevant bleeding (moderate or severe) was significantly higher with cryobiopsy (16.2%) compared to forceps biopsy (4.2%, p < 0.05).
Conclusions:
- Transbronchial cryobiopsy is associated with a significantly increased risk of bleeding compared to transbronchial forceps biopsy.
- The observed increase in bleeding risk is clinically relevant, necessitating enhanced precautions.
- Training and specific protocols for bleeding management are recommended for transbronchial cryobiopsy procedures.
Background:
Bronchoscopic cryobiopsy is a new method of bronchoscopic tissue sampling in interstitial lung disease. In case of transbronchial biopsies, the resultant tissue samples are of high quality, and the lung parenchyma seen in the samples is adequate for a histological diagnosis in most cases. Bleeding after transbronchial biopsy is the most important procedure- associated complication and may be life threatening. This study addresses the risk of bleeding of transbronchial cryobiopsy.
Methods:
In this prospective, randomized, controlled multicentre study 359 patients with interstitial lung disease requiring diagnostic bronchoscopic tissue sampling were included. Both conventional transbronchial forceps biopsy and transbronchial cryobiopsy were undertaken in each patient. The sequence of the procedures was randomized. Bleeding severity was evaluated semi-quantitatively as "no bleeding", "mild" (suction alone), "moderate" (additional intervention) or "severe" (prolonged monitoring necessary or fatal outcome), for each intervention.
Results:
In 359 patients atotal of 1160 cryobiopsies and 1302 forceps biopsies were performed. Bleeding was observed after forceps biopsy in 173 patients (48.2%) and after cryobiopsy in 261 patients (72.7%). Bleeding was significantly greater in the cryobiopsy group (cryobiopsy/forceps biopsy: no bleeding 27.3%/51.8%; mild 56.5%/44.0%; moderate 15.0%/4.2%; severe 1.2%/0%; p < 0.001). The rate of clinically relevant bleeding (moderate or severe) was higher after the cryobiopsy procedures compared to the forceps biopsies (16.2% vs. 4.2%, p < 0.05). No fatal bleeding complications occurred.
Conclusions:
Compared to transbronchial forceps biopsy, transbronchial cryobiopsy was associated with an increased risk of bleeding which is of clinical relevance. Therefore training and additional precautions for bleeding control should be considered.
Trial Registration:
The study was registered with clinicaltrials.gov ( NCT01894113 ).
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