Interventional Pulmonology

Accuracy and Feasibility of Electromagnetic Navigated Bronchoscopy under Nitrous Oxide Sedation for Pulmonary Peripheral Opacities: An Outpatient Study
Laurent Bertoletti^{a, e}, Aurélie Robert^b, Michèle Cottier^c, Marie Laure Chambonniere^d, Jean-Michel Vergnon^{a, e}

Departments of
^aChest Diseases and Thoracic Oncology,
^bRadiology,
^cCytology, and
^dPathology, Hôpital Nord, University Hospital of St Etienne and Université Jean Monnet, and
^eFrench-Speaking Group of Thoracic Endoscopy (GELF), Saint-Etienne, France

Address of Corresponding Author

Respiration 2009;78:293-300 (DOI: 10.1159/000226128)

  Key Words

• Bronchoscopy
• Electromagnetic navigated bronchoscopy
• Lung cancer
• Solitary pulmonary nodule

  Abstract

Background: Recent studies have described the promising method of electromagnetic navigated bronchoscopy (ENB) for diagnosis of peripheral solitary nodules. However, they require general anaesthesia or intravenous sedation. We wanted to know if ENB could be applied more easily in outpatients. Objectives: We prospectively evaluated the accuracy and the feasibility of ENB under local anaesthesia and nitrous oxide/oxygen inhalation as unique sedation in outpatients. Methods: After mapping time, the bronchoscopic procedure was carried out under local anaesthesia and nitrous oxide/oxygen inhalation with the unique help of the ENB to confirm the right position of the extended working channel before sampling. The primary end point was the accuracy of ENB and the secondary end point was the feasibility in outpatients. Results: Among 54 screened patients, 53 completed the study protocol. The overall diagnostic success rate to diagnose malignancy was 71.4% in tumours of 28 mm in median size. ENB classified correctly peripheral lesions according to malignity in 41 cases (30 cases of cancer, 11 benign diagnosis) and failed in 12 cases (1 probable lung metastasis, 11 lung cancers). All patients but 1 were dismissed 1 h after the procedure and the tolerance of the procedure was excellent in all cases except 2 (agitation and anxiety). In two cases (4%) a pneumothorax was recorded, 1 requiring drainage with a chest tube during a short hospitalisation. Conclusions: ENB under nitrous oxide/oxygen sedation seems to be an accurate and safe procedure. In our series, it allowed us to obtain the diagnosis in 71.4% of the tumours, with a good tolerance and an outpatient strategy.

Copyright © 2009 S. Karger AG, Basel

  Author Contacts

Jean-Michel Vergnon
Department of Chest Diseases and Thoracic Oncology
University Hospital of St Etienne and Université Jean Monnet
FR–42000 Saint-Etienne (France), Tel. +33 4 7782 8314, Fax +33 4 7782 8090
E-Mail jean.michel.vergnon@univ-st-etienne.fr

  Article Information

Received: October 20, 2008
Accepted after revision: March 16, 2009
Published online: June 23, 2009
Number of Print Pages : 8
Number of Figures : 2, Number of Tables : 2, Number of References : 19