C23-05 Use of Single-use Flexible Bronchoscopes for Advanced Procedures: A Pilot Crossover Study

Abstract Background Flexible bronchoscopy is essential for diagnosing and managing airway disease. Reusable flexible bronchoscopes (RFBs), though standard, require expensive bronchoscopy towers, sterilization systems, and maintenance personnel, limiting their use in resource-constrained settings. Single-use flexible bronchoscopes (SUFBs) are increasingly implemented for basic bronchoscopy due to their lower infrastructure demands and reduced infection risk. While early benchtop and clinical studies show promise, their utility in advanced diagnostic and therapeutic bronchoscopic procedures remains unexplored. Methods We conducted a single-arm pilot crossover study assessing the clinical utility of the Vathin SUFB (sizes ID 3.2, 2.8, 2.0 mm) for advanced bronchoscopic procedures. Diagnostic procedures included radial Endobronchial ultrasound with cryobiopsy. Therapeutic procedures included: 1) central airway debridment with electrocautery, APC, or cryospray, 2) balloon dilation, 3) self-expanding metallic stent (SEMS) placement, 4) endobronchial valve (EBV) placement, and 5) percutaneous tracheostomy. If the bronchoscopist identified a need to switch to an Olympus RFB, this was deemed a crossover event. The primary outcome was crossover rate. Secondary outcomes included time and reason for crossover and operator-rated performance using a 5-point Likert scale (1 = very poor, 5 = very good) assessing image quality, maneuverability, flexion, suction, and procedure-specific tasks. Preliminary results are available for 18 patients. Results Eighteen patients with median age of 53.5 years underwent advanced bronchoscopy with diagnostic or therapeutic indication. Five patients underwent diagnostic bronchoscopy with radial EBUS and cryobiopsy, four for peripheral lung lesions suspicious for cancer and one for interstitial lung disease. Thirteen patients underwent therapeutic bronchoscopy for the following diagnoses: malignant central airway obstruction (MCAO) (n = 7), benign tracheal stenosis (BTS) (n = 3), emphysema due to alpha-1 antitrypsin deficiency (n = 1), and respiratory failure/prolonged intubation (n = 2). Therapeutic procedures were cryoextraction, electrocautery, SEMS placement, balloon dilation, EBV placement, and percutaneous tracheostomy. Median procedure time was 2 hours and 42 minutes. Crossover occurred in 2/18 (11%). In rEBUS with cryobiopsy, crossover occurred at 3.2 hours due to breakage of the control lever, resulting in loss of retroflexion. In EBV placement, crossover occurred at 68 minutes due to internal scope sheath peeling during valve deployment, dislodging a foreign impurity. Bronchoscope performance evaluation was performed for each procedure by the performing bronchoscopist (Table 1.) Conclusions In this pilot study, SUFB appears feasible and efficient for advanced bronchoscopy. Operator-rated performance was generally good to very good. Broader implementation of SUFB could enable advanced bronchoscopic procedures in resource-limited locations. This abstract is funded by: Hunan Vathin Medical Instrument Co., Ltd