ERS statement on interventional bronchoscopy in children: what we do and what we can do better
A recent ERS task force on paediatric bronchoscopy describes the evidence available at present and identifies areas deserving further study.
An ERS multidisciplinary task force recently performed a systematic review of the literature, focusing on interventional bronchoscopic techniques, such as whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids. The ERS group effort was important due to lack of published evidence in this field. For this reason, ERS group had to resort to the collective clinical experience of the committee to develop this statement.
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For example, whole lung lavage is performed in children with alveolar proteinosis, metabolic disorders such as lysinuric protein intolerance, Niemann-Pick disease or lipoid pneumonia. There is a lack of studies to assess the side-effects of the procedure on alveolar epithelium. The balloon dilation in children, performed in specialised centres, is therapeutic for tracheal and bronchial stenoses. The review also showed that repeated procedures are usually necessary to get effective results. Placing of biodegradable airway stents is useful either for temporary luminal stabilisation after airway surgery or relief of severe and refractory airway malacia or stenosis. We need for further studies to assess the utility of biodegradable stents. In children, cryotherapy, performing by using a freezing probe with liquid carbon dioxide, has been used in association with argon plasma coagulation for removing some bronchial carcinoma and inflammatory myofibroblastic tumour. No studies to assess the utility of cryotherapy in children.
The scarcity of knowledge underline the need for further research and proficient collaboration among competent paediatric bronchoscopists.
Ernst Eber, Juan L.Anton-Pacheco, Jacques de Blic, et al.ERS statement: interventional bronchoscopy in children. Eur Respir J 2017:50: 1700901.