Dual-scope method for hemostasis during transbronchial lung cryobiopsy

Rationale: Bleeding during transbronchial lung cryobiopsy can be clinically consequential. Conventional balloon occlusion and sequential 2-scope techniques may limit visualization or require bronchoscope exchange. We developed a dual-scope method in which an ultrathin bronchoscope for sampling and a therapeutic bronchoscope for balloon control are positioned simultaneously. Patient concerns: An 84-year-old man with a 0.6-cm peripheral right upper lobe nodule after prior resection of squamous cell carcinoma and a 55-year-old woman with a 1.2-cm peripheral right lower lobe nodule during surveillance for peritoneal cancer required tissue diagnosis. Diagnoses: In Case 1, a single cryobiopsy specimen was diagnostically adequate, showed no crush artifact, and revealed nonkeratinizing squamous cell carcinoma. Compared with the previously resected keratinizing squamous cell carcinoma, the lesion was considered more likely to represent a new primary lung cancer, although this could not be determined definitively from the bronchoscopic specimen alone. In Case 2, a single diagnostically adequate specimen without crush artifact showed acinar-forming adenocarcinoma; subsequent surgical resection confirmed primary lung adenocarcinoma, pT1aN0M0, stage IA1. Interventions: A 1.1-mm cryoprobe was advanced through the ultrathin bronchoscope, while a balloon catheter was positioned through the working channel of the therapeutic bronchoscope. Immediately after specimen retrieval, the balloon was inflated prophylactically under direct endoscopic observation. Outcomes: Balloon occlusion was maintained for 5 minutes in Case 1 and 3 minutes in Case 2. After balloon deflation, only a few milliliters of bleeding were observed in each case and resolved within a few seconds with suction alone. No repeat balloon inflation, topical hemostatic agent, or interruption of the procedure was required; bleeding was classified as Nashville Bleeding Scale grade 1 in both cases. Oxygen saturation remained 99% and 98% to 99%, respectively. Neither patient developed pneumothorax, delayed bleeding, or readmission due to a bronchoscopy-related complication. Lessons: These cases demonstrate the technical feasibility of simultaneous dual-scope positioning and real-time balloon management during Transbronchial lung cryobiopsy. They do not establish safety, reliability, or superiority over existing techniques; larger prospective studies using standardized bleeding assessment are required.