Bankstown Hospital - Grand Rounds - Further Reading

Welcome to the Grand Rounds Further Reading List, Respiratory edition, brought to you by the Clinical Library, on Level 4, next to the Auditorium.

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Agrawal, A. (2021). "Interventional Pulmonology: Diagnostic and Therapeutic Advances in Bronchoscopy." American Journal of Therapeutics 28(2): e204-e216 https://journals.lww.com/americantherapeutics/fulltext/2021/04000/interventional_pulmonology__diagnostic_and.6.aspx REQUEST ARTICLE

Background: Interventional pulmonology is a rapidly evolving subspecialty of pulmonary medicine that offers advanced consultative and procedural services to patients with airway diseases, pleural diseases, as well as in the diagnosis and management of patients with thoracic malignancy. Areas of Uncertainty: The institution of lung cancer screening modalities as well as the search of additional minimally invasive diagnostic and treatment modalities for lung cancer and other chronic lung diseases has led to an increased focus on the field of interventional pulmonology. Rapid advancements in the field over the last 2 decades has led to development of various new minimally invasive bronchoscopic approaches and techniques for patients with cancer as well as for patients with chronic lung diseases. Data Sources: A review of literature was performed using PubMed database to identify all articles published up till October 2020 relevant to the field of interventional pulmonology and bronchoscopy. The reference list of each article was searched to look for additional articles, and all relevant articles were included in the article. Therapeutic Advances: Newer technologies are now available such navigation platforms to diagnose and possibly treat peripheral pulmonary nodules, endobronchial ultrasound in diagnosis of mediastinal and hilar adenopathy as well as cryobiopsy in the diagnosis of diffuse lung diseases. In addition, flexible and rigid bronchoscopy continues to provide new and expanding ability to manage patients with benign and malignant central airway obstruction. Interventions are also available for diseases such as asthma, chronic bronchitis, chronic obstructive pulmonary disease, and emphysema that were traditionally treated with medical management alone. Conclusions: With continued high quality research and an increasing body of evidence, interventional bronchoscopy has enormous potential to provide both safe and effective options for patients with a variety of lung diseases.

Gesthalter, Y. B. and C. L. Channick (2024). "Interventional Pulmonology: Extending the Breadth of Thoracic Care." Annual Review of Medicine 75(Volume 75, 2024): 263-276 https://www.annualreviews.org/content/journals/10.1146/annurev-med-050922-060929 REQUEST ARTICLE

Interventional pulmonary medicine has developed as a subspecialty focused on the management of patients with complex thoracic disease. Leveraging minimally invasive techniques, interventional pulmonologists diagnose and treat pathologies that previously required more invasive options such as surgery. By mitigating procedural risk, interventional pulmonologists have extended the reach of care to a wider pool of vulnerable patients who require therapy. Endoscopic innovations, including endobronchial ultrasound and robotic and electromagnetic bronchoscopy, have enhanced the ability to perform diagnostic procedures on an ambulatory basis. Therapeutic procedures for patients with symptomatic airway disease, pleural disease, and severe emphysema have provided the ability to palliate symptoms. The combination of medical and procedural expertise has made interventional pulmonologists an integral part of comprehensive care teams for patients with oncologic, airway, and pleural needs. This review surveys key areas in which interventional pulmonologists have impacted the care of thoracic disease through bronchoscopic intervention.

Goussard, P., et al. (2023). "Complicated intrathoracic tuberculosis: Role of therapeutic interventional bronchoscopy." Paediatric Respiratory Reviews 45: 30-44 https://www.sciencedirect.com/science/article/pii/S1526054222000872 REQUEST ARTICLE

                In recent years bronchoscopy equipment has been improved with smaller instruments and larger size working channels. This has ensured that bronchoscopy offers both therapeutic and interventional options. As the experience of paediatric interventional pulmonologists continues to grow, more interventions are being performed. There is a scarcity of published evidence in the field of interventional bronchoscopy in paediatrics. This is even more relevant for complicated pulmonary tuberculosis (PTB). Therapeutic interventional bronchoscopy procedures can be used in the management of complicated tuberculosis, including for endoscopic enucleations, closure of fistulas, dilatations of bronchial stenosis and severe haemoptysis. Endoscopic therapeutic procedures in children with complicated TB may prevent thoracotomy. If done carefully these interventional procedures have a low complication rate.

Goussard, P., et al. (2023). "Complicated intrathoracic tuberculosis: Role of therapeutic interventional bronchoscopy." Paediatric Respiratory Reviews 45: 30-44 https://www.sciencedirect.com/science/article/pii/S1526054222000872 REQUEST ARTICLE

                In recent years bronchoscopy equipment has been improved with smaller instruments and larger size working channels. This has ensured that bronchoscopy offers both therapeutic and interventional options. As the experience of paediatric interventional pulmonologists continues to grow, more interventions are being performed. There is a scarcity of published evidence in the field of interventional bronchoscopy in paediatrics. This is even more relevant for complicated pulmonary tuberculosis (PTB). Therapeutic interventional bronchoscopy procedures can be used in the management of complicated tuberculosis, including for endoscopic enucleations, closure of fistulas, dilatations of bronchial stenosis and severe haemoptysis. Endoscopic therapeutic procedures in children with complicated TB may prevent thoracotomy. If done carefully these interventional procedures have a low complication rate.

Karir, A., et al. (2025). "An insight into interventional bronchoscopy." Clinical Medicine 25(3): 100321 https://www.sciencedirect.com/science/article/pii/S1470211825000399 REQUEST ARTICLE

                The emergent field of interventional bronchoscopy provides an alternative approach for the diagnosis and management of a range of respiratory conditions. Within malignant disease, robotic navigational bronchoscopy provides a stable platform to sample small and difficult to reach pulmonary nodules, while malignant central airway obstruction can be managed through transcopic stent insertion. A range of therapeutic modalities have been developed for benign disease, which provide alternatives to standard therapy, particularly in the context of endobronchial valves for chronic obstructive pulmonary disease, and bronchial thermoplasty for asthma, while transbronchial cryoexcision lung biopsy offers a non-surgical option for undiagnosed interstitial lung disease. With a rich pipeline of technology being developed through robust clinical trial processes, the field of interventional bronchoscopy will continue to grow to become an invaluable asset, not only to the field of respiratory medicine, but to the general physician.

Rozman, A., et al. (2024). "Interventional bronchoscopy in lung cancer treatment." Breathe (Sheff) 20(2): 230201 https://pmc.ncbi.nlm.nih.gov/articles/PMC11348910/

REQUEST ARTICLE

                Interventional bronchoscopy has seen significant advancements in recent decades, particularly in the context of lung cancer. This method has expanded not only diagnostic capabilities but also therapeutic options. In this article, we will outline various therapeutic approaches employed through either a rigid or flexible bronchoscope in multimodal lung cancer treatment. A pivotal focus lies in addressing central airway obstruction resulting from cancer. We will delve into the treatment of initial malignant changes in central airways and explore the rapidly evolving domain of early peripheral malignant lesions, increasingly discovered incidentally or through lung cancer screening programmes. A successful interventional bronchoscopic procedure not only alleviates severe symptoms but also enhances the patient's functional status, paving the way for subsequent multimodal treatments and thereby extending the possibilities for survival. Interventional bronchoscopy proves effective in treating initial cancerous changes in patients unsuitable for surgical or other aggressive treatments due to accompanying diseases. The key advantage of interventional bronchoscopy lies in its minimal invasiveness, effectiveness and favourable safety profile.

Therapeutic Guidelines -  Respiratory.

Available via CIAP (login required for home use).

BMJ Best Practice. Available via CIAP (login required for home use).