title: Endobronchial tumor debulking with a flexible cryoprobe for immediate treatment of malignant stenosis.
abstract: OBJECTIVE
  In addition to use of a laser, argon plasma coagulation, electrocautery, or coring with a rigid bronchoscope, tumor debulking with a flexible cryoprobe is used for therapeutic bronchoscopy with an immediate effect for endobronchial pathologies. We performed this analysis to determine the usefulness, efficacy, and safety of the flexible cryorecanalization in a large population under routine conditions.
  
  
  METHODS
  We identified 225 bronchoscopic interventions that were done as cryorecanalization with a flexible cryoprobe. All patients had symptomatic airway stenosis. We determined the endoscopic success rate and safety (bleeding and perforation) of the procedure.
  
  
  RESULTS
  Successful cryorecanalization was achieved in 205 (91.1%) of 225 patients. The flexible cryoprobe was used with all patients, in most patients in combination with flexible bronchoscopy and only in a minority (n = 31, 13.8%) in combination with a rigid bronchoscope. Additional interventional techniques used were endobronchial stents (n = 11, 4.9%) and argon plasma coagulation (n = 37, 16.4%). Mild bleeding (if ice-cold NaCl or epinephrine solution was necessary) occurred in 9 (4.0%) patients, moderate bleeding (if argon plasma coagulation or a bronchus blocker was required) occurred in 18 (8.0%) patients, and severe bleeding (events with hemodynamic instability) never occurred.
  
  
  CONCLUSIONS
  Cryorecanalization with the flexible cryoprobe for treatment of symptomatic endobronchial tumor stenosis is a safe technique with a high success rate and immediate treatment effect.
authors.affiliation: Center of Internal Medicine, Clinic of Internal Medicine II, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany. christian.schumann@uniklinik-ulm.de
authors.forename: Christian
authors.initials: C
authors.lastname: Schumann
authors.forename: Martin
authors.initials: M
authors.lastname: Hetzel
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Babiak
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hetzel
authors.forename: Tobias
authors.initials: T
authors.lastname: Merk
authors.forename: Thomas
authors.initials: T
authors.lastname: Wibmer
authors.forename: Philipp M
authors.initials: PM
authors.lastname: Lepper
authors.forename: Stefan
authors.initials: S
authors.lastname: Krüger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D001982:Bronchial Diseases / Q000150:complications / Q000601:surgery*; D001984:Bronchial Neoplasms / Q000150:complications / Q000601:surgery; D001999:Bronchoscopy; D003251:Constriction, Pathologic; D003452:Cryosurgery / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014133:Tracheal Diseases / Q000150:complications / Q000601:surgery*; D014134:Tracheal Neoplasms / Q000150:complications / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult