Safety and tolerance of transbronchial lung biopsy with cryoprobes vs conventional forceps

Background: Bronchoscopic transbronchial biopsy (TBLB) by the use of cryoprobes has been described as a feasible procedure to obtain lung samples. Objectives: To determine safety of TBLB with cryoprobes vs conventional forceps. To compare the procedure length and patients' tolerance with both techniques. Patients and methods: Patients with interstitial lung diseases referred to perform a TBLB were prospectively randomized in: Group 1: cryoprobe (Erbocryo CA®) and Group 2: conventional forceps. Patients in group 1, under deep sedation, were intubated to allow quick cryoprobe and bronchoscope introduction and removal. Bronchoscopies in group 2 were performed under conscious sedation. Tolerance questionnaires, number of biopsies, procedure's duration and related complications were registered. Results: Cryoprobe Forceps P value N 27 28 NSP Number of biopsies 3,6±0,9 3,5±1,2 NSP Duration (min) 30,8±6,9 32,6±9,3 NSP Tolerance: Qualitative scale (a) 95,4 47,8 p < 0,05 Tolerance: Quantitative scale (cm) (b) 2,5±2,2 1,4±2,8 p<0,05 Data is expressed as mean ± SD. (a) Patient's % scoring 1 (good tolerance). (b) VAS. Distance from 0 (bad tolerance). Cryoprobe (%) Forceps (%) None 3 (11,2) 5 (17,9) Bleeding I (a) 6 (23,2) 12 (42,9) Bleeding II (b) 16 (59,3) 10 (35,7) Bleeding III (c) 0 (0) 0 (0) Pneumothorax 2 (7,4) 2 (7,2) Chest pain 1 (3,7) 1 (3,6) (a) Mild, no specific treatment is needed; (b) moderate, controlled with standard haemostatic techniques; (c) severe, requiring extra haemostatic treatments, interrupting the procedure. NS p value. Conclusions: No safety differences have been observed between both techniques. Better tolerance in the cryoprobe group was probably due to the anaesthesic management.