Letter to the Editor
Use of an Occlusion Balloon in Transbronchial Lung Cryobiopsy
Utilización de un balón de oclusión en la realización de biopsias pulmonares transbronquiales con criosonda
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"descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">a) Imagen endoscópica de la colocación del balón de oclusión paralelo a la criosonda en la entrada de un bronquio segmentario pulmonar del lóbulo inferior derecho (LID). b) Imagen endoscópica del balón de oclusión insuflado tras la realización de una biopsia pulmonar transbronquial.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Virginia Pajares Ruiz, Alfons Torrego Fernández, Carmen Puzo Ardanuy, Angels Gil de Bernabé" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Virginia" "apellidos" => "Pajares Ruiz" ] 1 => array:2 [ "nombre" => "Alfons" "apellidos" => "Torrego Fernández" ] 2 => array:2 [ "nombre" => "Carmen" "apellidos" => "Puzo Ardanuy" ] 3 => array:2 [ "nombre" => "Angels" "apellidos" => "Gil de Bernabé" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212914001499" "doi" => "10.1016/j.arbr.2014.05.013" 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"formatos" => array:3 [ "EPUB" => 160 "HTML" => 5537 "PDF" => 636 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "A Comparison of the Impact Factor and the <span class="elsevierStyleItalic">SCImago Journal Rank</span> Index in Respiratory System Journals" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "308" "paginaFinal" => "309" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comparación del factor de impacto y el índice <span class="elsevierStyleItalic">SCImago Journal Rank</span> en las revistas del sistema respiratorio" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Eduardo García-Pachón, Ricardo Arencibia-Jorge" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Eduardo" "apellidos" => "García-Pachón" ] 1 => 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"paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "309" "paginaFinal" => "310" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Virginia Pajares Ruiz, Alfons Torrego Fernández, Carmen Puzo Ardanuy, Angels Gil de Bernabé" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Virginia" "apellidos" => "Pajares Ruiz" "email" => array:1 [ 0 => "vpajares@santpau.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Alfons" "apellidos" => "Torrego Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Carmen" "apellidos" => "Puzo Ardanuy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Angels" "apellidos" => "Gil de Bernabé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Departamento de Medicina, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilización de un balón de oclusión en la realización de biopsias pulmonares transbronquiales con criosonda" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 682 "Ancho" => 1301 "Tamanyo" => 141623 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Endoscopic image of the occlusion balloon placed parallel to the cryoprobe in the entrance to the right lower lobe (RLL) segmental bronchus. (b) Endoscopic image of the inflated occlusion balloon after performing the transbronchial lung biopsy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">With the aim of improving the diagnostic yield of transbronchial lung biopsy, cryotherapy probes have begun to be used for obtaining lung specimens. Studies evaluating the histological material from endobronchial tumors obtained by cryobiopsy have found that the specimens obtained are larger than those obtained with conventional forceps, and that the quality for histology is better.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> From these data, the possibility of using cryoprobes as an alternative to the conventional method in the study of diffuse parenchymal lung disease has been proposed, and the results suggest that the technique improves diagnostic efficacy.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Similarly, descriptive studies aimed at analyzing the viability and the safety of the technique have been performed and have shown no increase in adverse effects, even in lung transplantation patients.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In this respect, the authors have analyzed the data from 77 patients with suspected diffuse interstitial disease randomized to undergo transbronchial lung biopsy with cryoprobe (39 patients) or conventional forceps (38 patients). A greater number of patients in the cryobiopsy group presented moderate bleeding compared to the conventional group (56.4% versus 34.2%, <span class="elsevierStyleItalic">P</span>=.068). However, this bleeding was not significant, the patients did not require other medical or surgical interventions, and the time of the procedure was not increased. For classification purposes, any bleeding that required suction and occlusion of the segmental bronchus was considered as moderate.</p><p id="par0015" class="elsevierStylePara elsevierViewall">One of the features of this new technique is that, due to the size of the biopsies obtained, the bronchoscope has to be withdrawn with the specimen attached to the tip of the probe; therefore, unlike the conventional method, the endoscopic vision of the bronchial tree is lost for some seconds. Re-introduction of the bronchoscope and occlusion manoeuvres in the segmental bronchus in which the cryobiopsy has been performed may be complicated by the presence of bleeding. In this respect, the aim of using an occlusion balloon is not to reduce the amount of bleeding, but rather to provide better control of bleeding, should it occur. This aspect represents a change in the technique previously described by this group.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Accordingly, before starting the procedure, an occlusion balloon is introduced (Model B5-2C<span class="elsevierStyleSup">®</span>, Olympus Medical Systems Corp, Tokyo, Japan) via the side channel of the endotracheal tube (Reference 104100. Broncoflex<span class="elsevierStyleSup">®</span> 7.5<span class="elsevierStyleHsp" style=""></span>mm, Rüsch, Teleflex Medical, Durham, US) and placed at the entrance to the lung segment from which the transbronchial lung biopsy is to be obtained. Immediately after the specimen is obtained, the occlusion balloon is inflated until absence of bleeding is confirmed on endoscopy.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In conclusion, the preventive use of a hemostatic balloon allows the bleeding to be limited to an occluded area, in the case of hemorrhage. Although this does not directly reduce the intensity of any possible bleeding, it does facilitate endoscopy guiding (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pajares Ruiz V, Torrego Fernández A, Puzo Ardanuy C, Gil de Bernabé A. Utilización de un balón de oclusión en la realización de biopsias pulmonares transbronquiales con criosonda. Arch Bronconeumol. 2014;50:309–310.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 682 "Ancho" => 1301 "Tamanyo" => 141623 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Endoscopic image of the occlusion balloon placed parallel to the cryoprobe in the entrance to the right lower lobe (RLL) segmental bronchus. (b) Endoscopic image of the inflated occlusion balloon after performing the transbronchial lung biopsy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Old meets modern: the use of traditional cryoprobes in the age of molecular biology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Hetzel" 1 => "M. Hetzel" 2 => "C. Hasel" 3 => "P. Moeller" 4 => "A. Babiak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000135934" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2008" "volumen" => "76" "paginaInicial" => "193" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18708736" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Hetzel" 1 => "R. Eberhardt" 2 => "F.J. Herth" 3 => "C. Petermann" 4 => "G. Reichle" 5 => "L. Freitag" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/09031936.00033011" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2012" "volumen" => "39" "paginaInicial" => "685" "paginaFinal" => "690" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21852332" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transbronchial cryobiopsy: a new tool for lung biopsies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Babiak" 1 => "J. Hetzel" 2 => "G. Krishna" 3 => "P. Fritz" 4 => "P. Moeller" 5 => "T. Balli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000187134" "Revista" => array:6 [ "tituloSerie" => "Respiration" "fecha" => "2009" "volumen" => "77" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19145104" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cryoprobe transbronchial lung biopsy in lung transplant patients: a safety pilot" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Yarmus" 1 => "J. Akulian" 2 => "C. Gilbert" 3 => "P. Illei" 4 => "P. Shah" 5 => "C. Merlo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.12-2290" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2013" "volumen" => "143" "paginaInicial" => "621" "paginaFinal" => "626" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23328889" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transbronchial lung biopsy using cryoprobes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V. Pajares" 1 => "A. Torrego" 2 => "C. Puzo" 3 => "E. Lerma" 4 => "M.A. Gil de Bernabé" 5 => "T. Franquet" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2009.09.012" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2010" "volumen" => "46" "paginaInicial" => "111" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19939546" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000007/v1_201406290026/S1579212914001499/v1_201406290026/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000007/v1_201406290026/S1579212914001499/v1_201406290026/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001499?idApp=UINPBA00003Z" ]
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