Airway spray cryotherapy: initial outcomes from a multiinstitutional registry.

BACKGROUND: Spray cryotherapy (SCT) uses a noncontact system to deliver liquid nitrogen (2 to 4 psi) through an endoscopic catheter. Rapid freezing and thawing of tissue causes cellular death and is also hemostatic. We report the preliminary results from 6 institutions in which SCT was used for the treatment of malignant airway tumors. METHODS: SCT was performed on patients with symptomatic airway tumors and reviewed retrospectively. Airway narrowing was graded as 25% or smaller, 26% to 50%, 51% to 75%, and exceeding 75%. All events were documented and assessed. RESULTS: Eighty patients (45 male [56%]) underwent 114 treatments. Median age was 66 years (range, 15 to 90 years). All patients were treated with minimal blood loss. Fifty-eight percent of the cases were outpatient procedures. Airway obstruction exceeded 75% in most of the lesions treated. There were 21 intraoperative events (19%), including hypotension, bradycardia and tachycardia, ST segment changes, desaturation, and an airway tear. Three pneumothoraces occurred, one requiring emergency chest tube placement. Two intraoperative deaths were associated with bradycardia. Three postoperative deaths occurred in patients who were transitioned to comfort care. All but 1 patient had airway patency after treatment. CONCLUSIONS: SCT can be used in patients with highly vascular tumors, with reduced bleeding complications and a low overall complication rate. Caution is needed before SCT is used on a widespread basis, given the intraoperative complications. Although the potential benefit of SCT is considerable, this needs to be confirmed in larger studies.

Feasibility of spray cryotherapy and balloon dilation for non-malignant strictures of the airway.

OBJECTIVE: Benign airway strictures can be complex and challenging to manage. Although resection is preferred, this is not always feasible, and hence, endoscopic therapies are often performed. However, endoscopic therapies can be problematic, with granulation tissue and fibrosis leading to early failure. Spray cryotherapy (SC) is a new approach that may modulate the healing response leading to less fibrosis and decrease the need or the duration of time to intervention. We report the initial results of SC for benign airway strictures. METHODS: Over a 22-month period, 35 patients underwent SC. Median age was 51(18-81) years. Prior therapy had been undertaken in 14 (41.2%) of patients. Stricture etiology included post intubation (n=5), prior tracheostomy (n=6), radiation induced (n=2), prior surgery (n=3), other causes (n=12), or unknown etiology (n=7). Airway narrowing was graded as follows: 1=0-25%, 2=26-50%, 3=51-75%, and 4=76-100%. For the purpose of analysis, this was treated as a continuous variable. The usual treatment algorithm consisted of ×3-4 SC cycles, followed by balloon dilation, and then by additional SC cycles. RESULTS: Stricture locations were subglottic (n=18), tracheal (n=9), and bronchial (n=8). Seventeen (49%) patients required additional SC therapy, resulting in a total of 63 SC treatment sessions. Only two (3.2%) complications occurred and these included pneumothorax (n=1) and intra-operative tracheostomy (n=1). Mean follow-up was available in 33/35 patients at a mean of 8.2 (1-19) months. Twelve (of 33) patients (36.4%) were asymptomatic, 16/33 (48.5%) were improved, 4/33(12.1%) had no improvement or were worse, and 1/33(3%) patient died from an unrelated cancer. On follow-up bronchoscopy, performed in 28 patients, airway narrowing improved significantly from 3.5 to 2.03 (p<0.001). CONCLUSIONS: Initial experience with SC for benign airway strictures suggests that this can be used safely. This is effective in improving symptoms and reducing the severity of airway narrowing. Re-intervention is still required. Further study should be undertaken to determine factors that may be associated with success or failure as well as the relative efficacy of SC compared with other endoscopic therapies.