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Background A systematic assessment of comprehensive clinical outcomes after various therapeutic procedures for malignant central airway obstruction (CAO) is lacking. Methods Patients with symptomatic malignant CAO undergoing various therapeutic bronchoscopy procedures were assessed for symptomatic and functional improvement using the Speiser Score, spirometry, 6-minute walk distance (6MWD), and St. George Respiratory Questionnaire (SGRQ) up to 3 months after the procedures. Results A total of 83 intervention procedures were performed in 65 patients, comprising 43 (66.2%) male individuals [overall mean age, 52.4; SD, 15.4 y]. The majority of these (92.3%) was done using rigid bronchoscope under general anesthesia. Airway stenting was the most common intervention performed (56.6%), followed by mechanical debulking (26.5%), cryodebulking (6%), electrosurgical removal (4.8%), balloon dilatation (3.6%), and laser ablation (2.4%).A total of 15 complications (18.1%) were noted. Of these, 8 (53.3%) were early complications and 7 (46.7%) were late complications. Early complications included airway bleeding, hypoxia, vocal cord injury, laryngeal injury, and pneumothorax. Late complications included significant granulation tissue formation in metallic stents and lung collapse because of mucus plug.The survival rates at 4, 8, and 12 weeks were 83%, 70.7%, and 66.1%, respectively. Significant improvement was observed in dyspnea, cough, Speiser Score, 6MWD, forced expiratory volume in 1 s, forced vital capacity, and SGRQ scores at 48 hours, 4 weeks, and at 12 weeks after the procedures and no procedure-related mortality occurred. Conclusion Various therapeutic bronchoscopic interventions, including combined modalities, provide rapid and sustained improvements in symptoms, respiratory status, exercise capacity, and quality of life in malignant CAO and have a good safety profile.

BACKGROUND There is debate regarding the ideal instrument for medical thoracoscopy. The authors compared rigid mini-thoracoscopy with semirigid thoracoscopy for thoracoscopic pleural biopsy. METHODS Consecutive subjects with undiagnosed exudative pleural effusion were randomized (1:1 ratio) to mini-thoracoscopy or semirigid thoracoscopy groups. The primary objective was a comparison of the diagnostic yield of pleural biopsy. Key secondary outcomes were the comparison of sedative/analgesic dose, operator-rated and patient-rated pain on visual analog scale (VAS), operator-rated overall procedural satisfaction (VAS), pleural biopsy size, and complications between the groups. RESULTS Of the 88 screened subjects, 73 were randomized: 36 to mini-thoracoscopy and 37 to semirigid thoracoscopy. Diagnostic yield of pleural biopsy in the mini-thoracoscopy (69.4%) and semirigid thoracoscopy groups (81.1%) was similar on intention-to-treat analysis (P=0.25). Although the operator-rated overall procedure satisfaction scores were similar between groups (P=0.87), operator-rated pain [VAS (mean±SD), 43.5±16.7 vs. 31.7±15.8; P

BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) as a standalone modality is superior to conventional TBNA (c-TBNA) for the diagnosis of sarcoidosis. However, the overall yield is not different if combined with endobronchial biopsy (EBB) and transbronchial lung biopsy (TBLB). The utility of rapid on-site evaluation (ROSE) in a comparative evaluation of EBUS-TBNA versus c-TBNA for the diagnosis of sarcoidosis has not been previously evaluated. METHODS Eighty patients with suspected sarcoidosis were randomized 1:1:1:1 into 4 groups: c-TBNA without ROSE (TBNA-NR), c-TBNA with ROSE (TBNA-R), EBUS-TBNA without ROSE (EBUS-NR), and EBUS-TBNA with ROSE (EBUS-R). EBB and TBLB were performed in all patients. Primary objective was detection of granulomas for combined procedure. Secondary objectives were individual procedure yields, sedation dose, and procedure duration. Patients without a diagnosis following c-TBNA subsequently underwent EBUS-TBNA. RESULTS A total of 74 patients were finally diagnosed with sarcoidosis. Overall, granuloma detection was not significantly different between the 4 groups (68% in TBNA-NR, 89% in TBNA-R, 84% in EBUS-NR, and 83% in EBUS-R groups, P=0.49). The yield of c-TBNA in the TBNA-NR group was lower compared with that in TBNA-R group and EBUS-TBNA in EBUS groups (32%, 72%, 68%, and 67% for TBNA-NR, TBNA-R, EBUS-NR, and EBUS-R groups, respectively, P=0.04). Additional 20% patients were diagnosed when EBUS-TBNA was performed following a nondiagnostic bronchoscopy procedure in the TBNA-NR group. Sedation requirement and procedure duration were significantly lower with c-TBNA as compared with EBUS-TBNA (P

Hemoptysis is common in pulmonary aspergilloma. Current treatment modalities such as surgical resection or bronchial artery embolization (BAE) are limited by lack of technical expertise and risk of recurrence, respectively. We describe our experience of treating aspergilloma and hemoptysis with bronchoscopic instillation of voriconazole.We retrospectively reviewed records of patients with symptomatic aspergilloma undergoing bronchoscopic voriconazole instillation. Four sessions were carried out at weekly intervals using 400 mg voriconazole dissolved in 20 mL 0.9% normal saline.A total of 82 subjects were evaluated [66 males; mean (SD) age, 43.2 (14.1) y]. The commonest underlying etiology was posttubercular sequelae (95.1%). Of these, 18 patients (22%) had BAE within the last 1 year. The mean (SD) size of aspergilloma was 4.5 cm (1.5 cm). Following voriconazole instillation, 25 patients (30.5%) had significant resolution of hemoptysis after first session, and 52 patients (68.3%) after the second session. Transient postprocedure cough (n=38; 46.3%) was the commonest procedure-related adverse event. Follow-up CT (n=47) showed reduction in aspergilloma size in 54% and no change in 40.4%. The median (IQR) hemoptysis-free period was 12 months (IQR, 9 to 15.5 mo). Recurrence of significant hemoptysis occurred in 24 (29.3%) patients during a median follow-up of 14.5 months (IQR, 9-18 mo). A history of prior BAE and baseline aspergilloma size were significantly associated with recurrence of significant hemoptysis.Intrabronchial voriconazole instillation seems to be a safe and effective modality for hemoptysis control in pulmonary aspergilloma.

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely accepted minimally invasive procedure for the evaluation of mediastinal lymphadenopathy. Most of the published literature on EBUS-TBNA is focused on the diagnostic and staging aspects of lung cancer. Literature on the utility of this modality from developing countries and settings with a high prevalence of tuberculosis (TB) is limited. We herein describe our preliminary experience over 1 year on the utility of EBUS-TBNA from a tertiary care teaching center in North India. Methods The primary objective was to evaluate the utility of convex probe EBUS-TBNA as a modality for diagnosis in patients with mediastinal lymphadenopathy presenting to our center. EBUS-TBNA was performed under local anesthesia and conscious sedation in the bronchoscopy laboratory. Rapid on-site evaluation was available for most of the procedures. Patients were discharged the same day from the hospital. Results A total of 102 patients with mean age of 42.1±14.2 years underwent EBUS-TBNA for a clinical indication of enlarged mediastinal lymph nodes, between September 2012 and September 2013.There were 63 males (61.8%) and 39 females (38.2%). EBUS-TBNA was performed for staging lung cancer in 5 patients.A total of 216 lymph node stations were sampled in 102 patients. Rapid on-site evaluation was performed in 95 patients (93.1%). Adequate/representative samples could be obtained in 98 of 102 patients (96.1%). Overall, EBUS-TBNA was diagnostic in 76 patients (74.5%). EBUS-TBNA was diagnostic in 80.9%, 84.8%, and 75% of patients with sarcoidosis, TB, and lung cancer, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA were 81.7%, 100%, 100%, and 22.73%, respectively. Conclusions EBUS-TBNA is a safe and efficacious procedure for obtaining tissue diagnosis in patients with mediastinal lymph node enlargement. The yield of EBUS-TBNA in diagnosis of mediastinal lymph node enlargement due to TB is especially high.