Stéphane Beaudoin

Healthcare utilization and health-related quality of life of adult survivors of preterm birth complicated by bronchopulmonary dysplasia.

This study aims to characterize the impact of preterm birth, respiratory distress syndrome and bronchopulmonary dysplasia on quality of life and healthcare utilization in adulthood.

Diagnostic yield of non-guided flexible bronchoscopy for peripheral pulmonary neoplasia.

The role of conventional bronchoscopy for peripheral pulmonary neoplasia remains controversial. We aimed to assess the diagnostic yield and the added value of non‐guided bronchial aspiration, bronchoalveolar lavage (BAL), and brushing for the diagnosis of pulmonary neoplasia not visible endoscopically.

Randomized Trial Comparing Patient Comfort Between the Oral and Nasal Insertion Routes for Linear Endobronchial Ultrasound.

Background:Linear endobronchial ultrasound (EBUS) is a safe and accurate sampling method for mediastinal adenopathy. The transnasal approach has been proposed to improve patient comfort, but no data compare the oral and nasal routes. The objective was to compare patient comfort during linear EBUS under conscious sedation between the oral and the nasal routes. Methods:An open-label randomized study comparing the 2 insertion routes for linear EBUS was conducted. Standardized protocols for sedation and topical anesthesia were used. Primary outcome was subjects’ comfort measured by a 10-point scale filled 2 hours after the procedure. Willingness to return for a repeat examination, procedural characteristics, complications, and diagnostic yields were also compared. Results:A total of 220 subjects were randomized and allocated to the nasal (n=110) or oral (n=110) route. Twenty-seven subjects in the nasal group (24.5%) had a failed nasal insertion but were analyzed in the nasal group. Procedural characteristics were similar (EBUS duration, doses of sedatives and lidocaine, number of stations sampled, complications). There was no difference between the nasal and oral groups in subjects’ comfort (8.3 vs. 8.3, respectively, P=0.99), overall patient satisfaction (8.9 vs. 9.1, respectively, P=0.34), subjects’ willingness to return (96% vs. 97%, P=1.00), and physician-reported subject comfort. Rates of adequate specimens and diagnostic yields did not differ significantly between the groups. Conclusions:For linear EBUS, the nasal and oral approaches confer a similarly high degree of patient comfort with similar complication rates and diagnostic yield. Patient and physician preferences should dictate the route of insertion.

Influence of trainee involvement on procedural characteristics for linear endobronchial ultrasound

Linear endobronchial ultrasound (EBUS) is a safe and effective method for the diagnostic sampling of mediastinal lymph nodes. However, there is a learning curve associated with the procedure and operator experience influences diagnostic yield. We sought to determine if trainee involvement during EBUS influences procedural characteristics, complication rate, and diagnostic yield.

Dislodgement of Radial EBUS-Guide Sheath Radiopaque Cuff: A Rare Complication.

To the Editor: Radial probe endobronchial ultrasound (RP-EBUS) is recommended as an adjunct modality for the diagnosis of peripheral pulmonary lesions based on its favorable safety profile and its reasonable diagnostic yield.1 In a retrospective study of 965 consecutive procedures,2 a complication rate of 1.3% (0.8% pneumothorax, 0.5% infection) was reported, with no guide sheath breakage. Guide sheath dysfunction was not observed in a multicenter prospective registry3 nor in a meta-analysis of RP-EBUS studies.4 We herein report 2 cases of guide sheath breakage, review 2 additional cases, and offer possible explanations. A 65-year-old woman underwent RP-EBUS (using the UM-S20-20R-3 probe and the K-203 kit from Olympus Canada Inc.) for a 5.2 cm subpleural mass in the posterior segment of the right lower lobe. The lesion was localized using RP-EBUS, with a central probe position. Five transbronchial needle aspiration (TBNA) passes, 6 transbronchial biopsies (TBBx), 1 brushing, and 1 bronchoalveolar lavge were performed in that order. After TBNA, the guide sheath was noted to be displaced and tore at its tip. Sampling proceeded after replacing the guide sheath, but the radiopaque cuff remained in the airways. It was removed using forceps under fluoroscopy. The procedure was prolonged by several minutes, without adverse consequences. A 75-year-old man with a history of granulomatosis with polyangiitis underwent RP-EBUS for a centrally located 2.7 cm branching opacity in the posterior segment of the right upper lobe. The lesion was localized with a central probe position. Five TBNA passes, 1 brushing, and 3 TBBx were performed. When the biopsy forceps were introduced for the fourth biopsy, resistance was encountered and the forceps were withdrawn. It was then noted that the radiopaque cuff was dislodged. Forceps were used to retrieve the cuff under fluoroscopy. The retrieval added several minutes to the procedure, with no adverse consequences. When the guide sheath was removed, it was compressed and torn at the end. The compression of the guide sheath is thought to have been caused by the acute angle of the airway, compounded by the patient’s excessive cough. Over 200 RP-EBUS procedures have been performed at our institution since 2009. Although deformation and flattening of the Olympus guide sheath is frequently observed upon its removal from the bronchoscope, dislodgement of the distal radiopaque cuff was only seen twice. This complication has never been formally described in the literature, although 2 Food and Drug Administration Manufacturer And User facility Device Experience (MAUDE) reports describe such an occurrence.5 Potential causes of breakage of the guide sheath are numerous. A product defect could be responsible, but the manufacturer’s examination in the 2 MAUDE reports failed to reveal such an anomaly. Our 2 cases were separated by almost 1 year, excluding a lot manufacturing issue. However, the characteristics of the guide sheath are such that it can buckle at acute angles, collapse, and even shrink during sampling. The buckling can be a factor leading to perforation of the guide sheath. With repeated instrument insertion and removal, the cuff can then break off. This phenomenon is thought to be more likely when the target is reached through tortuous airways at sharp angles. But misuse of sampling tools may also explain sheath dysfunction. In one of the MAUDE report, the manufacturer concluded that the operator attempted to remove the biopsy forceps from the guide sheath while the cups were open. In the other report, repeated extension and withdrawal of a steerable curette from the guide sheath was thought to be the culprit factor. Furthermore, deployment of a TBNA needle proximal to the radiopaque cuff could lacerate the guide sheath and cause cuff dislodgement, especially if there is an acute angle in the sheath or if it is buckled. Even if deployed appropriately, the back-and-fourth motion required for TBNA sampling may damage the sheath, espcially if it is bent. These mechanisms probably played a role in the first case we described. The same could happen if the brush or forceps are deployed or opened inside the guide sheath. Disclosure: There is no conflict of interest or other disclosures. DOI: 10.1097/LBR.0000000000000303 LETTERS TO THE EDITOR