Efficacy of Foreign Body Removal using a Cryoprobe in Flexible Bronchoscopy

Article information

Kosin Med J. 2014;29(1):31-36

Publication date (electronic) : 2014 December 17

doi : https://doi.org/10.7180/kmj.2014.29.1.31

Go Eun Yeo , Sung-Jin Nam , Yu Jin Han , Eun Jeong Kim , Nam Kyu Kim , So Young Ock , Weon Hyoung Lee , Chul Ho Oak , Mann Hong Jung , Tae Won Jang

Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: Chul Ho Oak, Department of Internal Medicine, College of Medicine, Kosin University, 34 Amnamdong, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-6104 FAX: +82-82-51-990-3049 E-mail: oaks70@daum.net

Received 2013 June 18; Revised 2013 August 27; Accepted 2013 October 16.

Abstract

Objectives

Endobronchial foreign body impaction is a medical emergency because of the air way obstruction. Therefore, immediate foreign body removal is crucial in such situations. Recently, there have been several reports about cryoprobe use as a tool for removal of foreign bodies. In this study, we determined the efficacy and complications of foreign body removal using a cryoprobe during flexible bronchoscopy.

Methods

This is a retrospective review of 27 patients who visited Kosin University Gospel Hospital from August 2007 to August 2010 with respiratory symptoms due to a foreign body in the airway. There were 17 males and 10 females, aged from 7 to 78 years. The foreign bodies were more frequently located (55%) in the right bronchus. The cryoprobe was inserted through the forceps channel of the flexible bronchoscope under local anesthesia. The lesion was quickly frozen for 5 seconds at -80℃, and the bronchoscope was removed with the probe after crystal formation on the contacted area.

Results

The success rate of removal of foreign bodies was 85% (23/27) using the cryoprobe. One case of broncholith did not undergo attempted removal because of the possibility of excessive hemorrhage by the tight bronchus impaction, and three cases (plastic, silicon, and implant) failed due to limited crystal formation. There were no severe hemorrhages, arrhythmias, or casualties during the procedure.

Conclusions

The removal of foreign body using a cryoprobe during flexible bronchoscopy was shown to be safe and effective. The nature of the material should be attempted before removing a foreign body.

Keywords: Airway; Cryoprobe; Endobronchial foreign body

Fig. 1.

The system for cryoprobe removal, a) cryosurgical unit b) flexible cryoprobe and c)pedal of the cryosurgical unit.

Fig. 2.

a) Broncholith was removed by cryotherapy through flexible bronchoscopy. b) The length of a removed stone at the right middle bronchus was 1.3 cm. (Reference: A Case of Endobronchial Actinomycosis with Broncholith Removed by Cryotherapy through Flexible Bronchoscopy. Scheduled to be published in Kosin Medical Journal, December of 2013).

Fig. 3.

a) A fish bone was extracted from the bronchus. b) Size of the extracted fishbone compared with a human finger tip. c) An impacted artificial tooth crown was seen on bronchoscopy. d) The artificial tooth crown was successfully extracted.

Table 1.

Patient demographics and accompanying symptoms

Table 2.

Location of impacted foreign bodies

Table 3.

Types of foreign bodies

Table 4.

Removal method and number of foreign bodies

References

1. Son CY, Wee JO, Kim SO, Oh IJ, Park CM, Kim KS, et al. A Retrospective Review of Tracheobronchial Foreign Bodies. Tuberc Respir Dis 2005;58:600–6.

2. Lee JH, Ahn JH, Shin AY, Kim SJ, Kim SJ, Cho GM, et al. A Promising Treatment for Broncholith Removal Using Cryotherapy during Flexible Bronchosopy: Two Case Reports. Tuberc Respir Dis 2012;73:282–7.

3. al-Majed SA, Ashour M, al-Mobeireek AF, al-Hajjaj MS, Alzeer AH, al-Kattan K. Overlooked inhaled foreign bodies: late sequelae and the likelihood of recovery. Respir Med 1997;91:293–6.

4. Rafanan AL, Mehta AC. Adult airway foreign body removal. What's new? Clin Chest Med 2001;22:319–30.

5. Ramirez-Figueroa JL, Gochicoa-Rangel LG, Ramirez-San Juan DH, Vargas MH. Foreign body removal by flexible fiberoptic bronchoscopy in infants and children. Pediatr Pulmonol 2005;40:392–7.

6. Lamaze R, Tréchot P, Martinet Y. Bronchial necrosis and granuloma induced by the aspiration of a tablet of ferrous sulphate. Eur Respir J 1994;7:1710–1.

7. Debeljak A, Sorli J, Music E, Keceli P. Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998. Eur Respir J 1999;14:792–5.

8. Burton EM, Brick WG, Hall JD, Riqqs W Jr, Houston CS. Tracheobronchial foreign body aspiration in children. South Med J 1996;89:195–8.

9. Shivakumar AM, Naik AS, Prashanth KB, Shetty KD, Praveen DS. Tracheobronchial foreign bodies. Indian J Pediatr 2003;70:793–7.

10. Ramírez-Figueroa JL, Gochicoa-Rangel LG, Ramírez-San Juan DH, Vargas MH. Foreign body removal by flexible fiberoptic bronchoscopy in infants and children. Pediatr Pulmonol 2005;40:392–7.

11. Lyu J, Song JW, Hong SB, Oh YM, Shim TS, Lim CM, et al. Bronchoscopic Cryotherapy in Patients with Central Airway Obstruction. Tuberc Respir Dis 2010;68:6–9.

12. Hsu WC, Sheen TS, Lin CD, et al. Clinical experiences of removing foreign bodies in the airway and esophagus with a rigid endoscope: a series of 3217 cases from 1970 to 1996. Otolaryngol Head Neck Surg 2000;122:450–4.

13. Cohen SR, Herbert WI, Lewis GB Jr, Geller KA. Foreign bodies in the airway: five-year retrospective study with special reference to management. Ann Otol Rhinol Laryngol 1980;89:437–42.

14. Oguzkaya F, Akcali Y, Kahraman C, Bilgin M, Sahin A. Tracheobronchial foreign body aspirations in childhood: a 10-year experience. Eur J Cardiothoracic Surg 1998;14:388–92.

15. Gorenstein A, Neel HB, Sanderson DR. Transbronchoscopic cryosurgery of respiratory structures: experimental and clinical studies. Ann Otol Rhinol Laryngol 1976;85:670–8.

16. Limper AH, Prakash UB. Tracheobronchial foreign bodies in adults. Ann Intern Med 1990;112:604–9.

17. Kim YH, Choi CW, Choi HS, Park MJ, Kang MH, Yoo JH. Clinical Features of Tracheobronchial Foreign Bodies in Adults according to the Risk of Aspiration. Tuberc Respir Dis 2008;64:356–61.

18. Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies: presentation and management in children and adults. Chest 1999;115:1357–62.

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