Indications, techniques, and safety of cryotherapy and cryobiopsy via flexible bronchoscopy in pediatric patients

RATIONALE: Cryotherapy and its diagnostic analogue, cryobiopsy, are emerging techniques via bronchoscopy with a wide range of clinical applications. While the use of cryotherapy and cryobiopsy has been established in adult pulmonary medicine, pediatric data describing the indications, procedural specifics, outcomes, and complications are limited. OBJECTIVE: To describe the indications, procedural specifics, outcomes, and complications of cryotherapy and cryobiopsy use in pediatric bronchoscopy. METHODS: A multicenter retrospective observational study was conducted at five pediatric hospitals in the United States. Patients aged 0 to 21 years who underwent cryotherapy or cryobiopsy via bronchoscopy between January 2017 and January 2025 were included. RESULTS: A total of 317 cryotherapy and cryobiopsy procedures were performed in 187 patients (median age 10 [3, 15] years; 44% female). The most common indication was cryoextraction (50%), followed by cryorecanalization (38%) and cryobiopsy (17%). The 1.1 mm cryoprobe was used in 57% of cases. Cryoextraction was at least partially successful in 95% of procedures, with the most common use being removal of blood clots (57%). Cryorecanalization was at least partially successful in 93% of procedures. The use of cryobiopsy has grown the most over the last two years. Cryobiopsy yielded successful histopathologic evaluation in 96% of biopsies with 73% diagnostic yield. Bleeding was the most common complication of cryotherapy occurring in 35% of cases, with 96% being Grade I or II. No pneumothorax was observed. Other complications were rare. CONCLUSIONS: Cryotherapy and cryobiopsy via bronchoscopy in pediatrics have been increasingly utilized, demonstrating high success and favorable safety profile. The introduction of the 1.1 mm cryoprobe has facilitated its broader application to pediatrics. Bleeding was the most common complication but was generally mild in the context of the selected cases at specialized centers.