TABLE 1

Summary of interventional bronchoscopy techniques available for the management of malignant central airway obstruction

StudiesAnaesthesiaPrincipleIndicationAdvantagesDrawbacks
Mechanical debulkingGeneralResection with the rigid tubes and forcepsProximal, slightly haemorrhagic, and intraluminal lesionsRapidity
Cost
Severe complications in 20% (bleeding, perforation)
LaserGeneral anaesthesia and rigid bronchoscopy highly recommended, except for limited degree of stenosis with short procedure timeShort pulsations in the bronchial axis at 30–50 W
Flexible or rigid bronchoscope
Intraluminal or mixed critical proximal obstructionsImmediate and prolonged debulking
Few complications if trained operator
Cost
Risk of perforation and bronchovascular fistula
Thermo-coagulation/argon plasma coagulation (APC)General anaesthesia and rigid bronchoscopy highly recommended, except for limited degree of stenosis with short procedure timeHigh-frequency electric current ± argon as a carrier gas (APC)Intraluminal or mixed proximal obstructionsImmediate efficacy
Cost
Low risk of perforation
APC: treatment of extended and haemorrhagic lesions
Risk of scarring stenosis if circumferential treatment
CryotherapyGeneral anaesthesia and rigid bronchoscopy highly recommended, except for limited degree of stenosis with short procedure timeExpansion of a cryogenic gas
Cycles of rapid freezing and slow thawing
Non-critical exophytic malignant obstructionsLow cost
Easy procedure
No perforation
Prolonged efficacy
Synergistic action with chemotherapy
Delayed effect (except cryoextraction and spray cryotherapy)
Need for a second cleaning bronchoscopy
Photodynamic therapyGeneral anaesthesia and rigid bronchoscopy highly recommended, except for limited degree of stenosis with short procedure timeActivation of a photosensitiser by lightNon-critical exophytic malignant obstructionsGood symptom control (haemoptysis)
Prolonged efficacy
Delayed effect
Retention of tumour material
Cleaning bronchoscopy
Phototoxicity
Constraining technique
Haemorrhagic complications
Silicone stentGeneralPlaced using a prosthesis pusher inserted in the rigid tubeExtrinsic or mixed compressionsGood tolerance
Few local granulomatous and ischaemic reactions
Easily removable
Altered ciliary clearance
Risk of migration (rare, except in cases of purely extrinsic compression)
Metallic stentGeneral anaesthesia and rigid bronchoscopy highly recommendedSelf-expandable
Placed using a guide wire under radiographic or bronchoscopic control
Flexible or rigid bronchoscopy
Second line; not to be considered as a first choice, except in cases of highly necrotic lesions or large distortionEasy placement
Possible with flexible bronchoscope (but should be avoided if rigid tube is unavailable)
Preserved clearance
Frequent complications (granuloma, perforation, rupture)
Hardly removable