Innovative Techniques Reduce Risks and Improve Outcomes
Physicians at Cincinnati Children’s Division of Pulmonary Medicine are advancing minimally invasive bronchoscopy techniques for pediatric lung conditions. Historically, advanced diagnostic and interventional bronchoscopy was limited for children because of the size gap between small pediatric airways and equipment designed for adults. Cincinnati Children’s pulmonologists have worked to bring these life-changing techniques to young patients, improving both diagnosis and treatment options for complex respiratory conditions.
The team has developed pediatric-specific approaches to advanced bronchoscopic procedures, such as endobronchial valve placement, endobronchial ultrasound (EBUS), cone beam CT (CBCT)-guided biopsy, whole lung lavage and cryotherapy. These tailored techniques aim to reduce risks and improve outcomes for children.
Innovative Interventional Techniques
Endobronchial valves are now used to manage persistent air leaks in the lungs of young patients, particularly for necrotizing pneumonia and end-stage lung disease. “There are probably less than a handful of programs in the country that do endobronchial valves for pediatric patients,” says Gregory Burg, MD, associate professor and pediatric pulmonologist in the Department of Pediatrics. “So we’ve had referrals come in just for persistent air leak and potentially to intervene endoscopically.”
Another essential tool is EBUS, which enables doctors to diagnose mediastinal masses through less invasive procedures. Rather than traditional surgical methods, physicians collect tissue samples using EBUS guided biopsies, allowing them to evaluate complex chest conditions with lower risk and greater patient comfort.
The team has also pioneered the use of CBCT-guided biopsies, using advanced 3D imaging to safely sample challenging peripheral lung nodules. By adopting CBCT, physicians can precisely guide instruments to the site of concern, thereby increasing diagnostic accuracy while minimizing risks to patients. This imaging technology is particularly valuable for small and difficult-to-access lung regions.
Also offered is whole lung lavage, a procedure Burg describes as “a controlled drowning of one lung to mobilize all the protein in that lung and clean it out.” This procedure primarily treats pulmonary alveolar proteinosis, a rare lung condition. Although the procedure is more common in adults, only a few children’s hospitals perform it on young patients.
Cryotherapy: A Trailblazer in Pediatric Care
Cryotherapy is another area where the pulmonology team is breaking new ground. This innovative technique uses extreme cold to remove foreign bodies and blood clots, debulk tumors, and sample the lung and mediastinal tissue. This provides a minimally invasive method to treat and diagnose young patients who would previously have had larger surgical procedures or gone undiagnosed. Erik Hysinger, MD, associate professor and pediatric pulmonologist in the Department of Pediatrics, is leading these efforts.
In September, Hysinger led an international seminar on pediatric cryotherapy at Cincinnati Children’s along with colleagues Sara Zak, MD, Dan Benscoter, DO, Cherie Torres-Silva, MD, Burg and others. The continuing medical education (CME) course included both lessons and hands-on training in applications like tissue debulking, devitalization and biopsy.
“The benefit of a cryo biopsy is that we can get larger pieces of tissue safely compared to traditional needle and forcep biopsies,” Hysinger says, adding that this approach has dramatically improved diagnostic yields.
Burg agrees: “Cryo biopsies are about three to four times the size of forceps biopsies, allowing us to get better quality tissue samples. Therefore, far fewer are needed.”
Physicians predict cryotherapy will become commonplace in pediatric pulmonology in the next five to 10 years, particularly for clot removal, foreign body extraction and airway recanalization.
Looking to the Future
Cincinnati Children’s improves outcomes for pediatric patients who need interventional pulmonary care by using advanced technologies and committing to education and collaboration. Cherie Torres-Silva, MD, and others participated in hands-on education utilizing the Research Interventional Radiology suite to perfect new techniques and future interventional pulmonary procedures. By adapting techniques initially developed for adults to meet the unique needs of children, the pediatric pulmonology team is raising the bar while shaping the future of respiratory care.
Despite the advancements, Hysinger acknowledges the challenges of broader adoption. “The field of pediatric interventional pulmonology is still developing, and the high cost of equipment is a major barrier for many institutions,” he says.
“It's important to think creatively when it comes to purchasing, maintaining and recovering the costs of new equipment,” says Carolyn Wallace, clinical manager of pulmonary bronchoscopy at Cincinnati Children’s. “Partnering with other departments to explore how endoscopic techniques can be used in conjunction with their services is an effective way to justify the expense of new equipment.”
Hysinger remains optimistic: “We’re [also] collaborating with industry partners to develop smaller, more affordable devices specifically for pediatric use. These pioneering procedures offer new hope for young patients with complex lung conditions.”
(Published December 2024)
