Sustained Clinical Benefits of Spiration Valve System in Patients with Severe Emphysema: 24-Month Follow-Up of EMPROVE.

Follow-up of patients with emphysema treated with endobronchial valves is limited to 3-12 months after treatment in prior reports. To date, no comparative data exist between treatment and control subjects with a longer follow-up. To assess the durability of the Spiration Valve System (SVS) in patients with severe heterogeneous emphysema over a 24-month period.

The Utility of EBUS-Guided Transbronchial Forceps Biopsy With or Without an Electrocautery Knife for the Diagnosis of Mediastinal and Hilar Lymphadenopathy.

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been shown to have a high diagnostic yield for mediastinal and hilar lymph node sampling, particularly in diagnosing and staging non-small cell lung cancer. However, the diagnostic yield is lower in patients with granulomatous and lymphoproliferative disorders. We prospectively compared the feasibility, safety, and diagnostic yield of EBUS-guided lymph node forceps biopsy (EBUS-TBFB) with electrocautery knife compared to EBUS-TBNA of lymph nodes in patients with suspected granulomatous and lymphoproliferative disease.

Use of Mitomycin-C in Laryngotracheal Stenosis: A Focused Clinical Review.

Background: Therapeutic options for managing laryngotracheal stenosis (LTS) are limited. Endoscopy is a minimally invasive approach to treating LTS, but carries a high risk of stenosis recurrence. Mitomycin C (MMC) is often used as an adjunct therapy to delay the time to symptomatic recurrence of LTS.

Effect of Bronchoscopic Spray Cryotherapy and Ultra-low Temperature on Physical Properties of Metallic and Silicone Airway Stents.

Background: Bronchoscopic spray cryotherapy (SCT) is utilized in the field of interventional pulmonology for treating benign and malignant airway stenosis as a standard tool to maintain airway patency. Stent-related complications include tumor overgrowth, granulation tissue, and epithelialization. Thermal ablation can have a limited role in such scenarios due to the risk of airway fire and damage to the existing stent.

Variable Learning Curve of Basic Rigid Bronchoscopy in Trainees.

Background: Despite increased use of rigid bronchoscopy (RB) for therapeutic indications and recommendations from professional societies to use performance-based competency, an assessment tool has not been utilized to measure the competency of trainees to perform RB in clinical settings.

Objectives: The aim of the study was to evaluate a previously developed assessment tool - Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) - for determining the RB learning curve of interventional pulmonary (IP) trainees in the clinical setting and explore the variability of learning curve of trainees.

Methods: IP fellows at 4 institutions were enrolled.

The Impact of Thoracentesis On Postprocedure Pulse Oximetry.

Background: Although thoracentesis can offer considerable symptomatic relief to the patient, its physiologic impact on oxygen saturation has not been well established in the literature. This study aimed to evaluate the impact of thoracentesis on postprocedure pulse oximetry (SpO2) in an inpatient population.

Methods: A retrospective study of patients undergoing thoracentesis from January 2012 to November 2017 was performed.

Bronchoscopic ablation techniques in the management of lung cancer.

Central airway involvement is a common manifestation of lung cancer during the disease course. Some patients will require bronchoscopic therapeutic interventions to palliate symptoms, or less commonly to provide more definitive therapy of airway involvement. We describe an overview specifically of bronchoscopic ablative techniques that are available for use in malignant airway obstruction.

Tracheobronchial tuberculosis.

Tracheobronchial tuberculosis (TBTB) is reported in approximately 10% to 39% of the patients with pulmonary tuberculosis. It is defined as the tubercle infection of the trachea and or bronchi. Due to its non-specific presentation, insidious onset and normal chest radiography in about 10-20% of the patients, the diagnosis is delayed.

Bronchoscopic management of iatrogenic tracheal laceration using polyurethane-covered nitinol tracheal stents.

Iatrogenic tracheal laceration is a known complication of emergent endotracheal intubation. Patients with tracheal laceration present a therapeutic challenge. There is no established standard treatment approach in this patient population.

Bronchoscopic pursuit of the peripheral pulmonary lesion: navigational bronchoscopy, radial endobronchial ultrasound, and ultrathin bronchoscopy.

Purpose Of Review: Peripheral pulmonary lesions (PPL) are being diagnosed with increasing frequency, especially with the increased use of chest computed tomography (CT). Depending on the location and size, these lesions often present a diagnostic challenge in terms of the low yield of traditional bronchoscopic biopsy techniques or the risks of a percutaneous biopsy approach.

Recent Findings: Over the last several years, several different image-guided bronchoscopy techniques have emerged, including virtual bronchoscopic navigation, electromagnetic navigation bronchoscopy, radial endobronchial ultrasound, and ultrathin bronchoscopy.

Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report.

Background: Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians.

Construct validity of the Simbionix bronch mentor simulator for essential bronchoscopic skills.

Background: Although simulation-based bronchoscopy has been shown to be an effective training modality, formal assessment should still be performed as new technology emerges. We sought to validate a simulator in essential bronchoscopic tasks, and survey perceptions of bronchoscopists on simulation.

Methods: A cohort study at 2 medical centers used 3 groups to assess construct validity of the Simbionix Bronchoscopy Simulator: 7 first-year fellows with <10 bronchoscopies each (novice), 6 pulmonologists with 200 to 1000 bronchoscopies each (experienced), and 7 pulmonologists with >1000 bronchoscopies each (expert).

Lung cancer screening with low-dose computed tomography: an analysis of the MEDCAC decision.

Lung cancer is the leading cause of cancer death in the United States and worldwide. However, among the top 4 deadliest cancers, lung cancer is the only one not subject to routine screening. Optimism for an effective lung cancer-screening examination soared after the release of the National Lung Screening Trial results in November 2011.

Palliative interventional pulmonology procedures in the incarcerated population with cancer: a case series.

Rationale: Cancer is the second most common cause of death in incarcerated population and lung cancer is the most common cause of cancer death in this group. Inmates are excluded from most published surveys and research,thus the effectiveness of lung cancer palliation in this population is not known.

Objective: To report the feasibility and safety of palliative interventional pulmonary procedures in inmates with cancer.

The use of octreotide to manage symptoms of bronchorrhea: a case report.

Octreotide, a synthetic analogue of the hormone somatostatin, is primarily used in palliative medicine because of its antisecretory effect and has been shown to be effective in the management of bowel obstruction, nausea, and diarrhea. Octreotide also has been successfully used for the management of bronchorrhea in both inpatient and outpatient settings. We report the case of a 47-year-old female with a history of bronchioloalveolar cell carcinoma whose copious bronchial secretions were controlled with octreotide.

Quality-of-life improvement and cost-effectiveness of interventional pulmonary procedures.

Most interventional pulmonology studies focus on the technical success of procedures without measuring validated quality-of-life (QoL) outcomes. Studies are now incorporating end points that include QoL measurements and there are examples of interventional procedures that likely improve QoL. It is vital for the interventional pulmonary literature to incorporate cost-effectiveness when introducing new technology.