Transbronchial lung cryobiopsy in interstitial lung disease: safety & learning curve

Introduction: Transbronchial lung cryobiopsy (TBCB) is a minimally invasive diagnostic procedure for patients with diffuse parenchymal lung disease. Pneumothorax occurs in approximately 19% of procedures and severe hemorrhage in Methods: We prospectively collected data of patients that underwent TBCB. The decision to perform TBCB was taken in the multidisciplinary ILD meeting. The procedure was performed either under general anesthesia with a rigid bronchoscope or cuffed ET tube, or under propofol sedation with a Rusch Bronchoflex tube. Arndt bronchial blockers were used to block the segmental or lobar bronchus after every biopsy in order to minimize bleeding. Patients were observed for 1 night at the clinic and before discharge a chest X-ray was performed. Results: Ninety-three patients underwent TBCB. The mean number of biopsies was 3,8 ±1,3. The overall pneumothorax rate was 15,1%. The annual rate of pneumothorax declined from 29% in 2015 to 8% in 2018 and 2019 (table 1). Bleeding was controlled in all cases with the bronchial blocker. 30-day moratilty was 1/93 (1%). Conclusions: Although TBCB is a safe procedure, there seems to be a clear learning curve with respect to the incidence of pneumothorax. Careful monitoring of complications is important to learn as a team and to minimize the morbidity. References: 1. Ravaglia C et al. BMC Pulm Med 2019;19:16.