Evaluation of the efficacy and safety of a new flex-rigid pleuroscope

Abstract

Objective: New flex-rigid pleuroscope enables observations with a maximum angle of curvature of 180^° , allowing visualization of the area near the insertion site of the pleuroscope. And, it improved the image quality and channel inner diameter. The aim of this study was to evaluate the clinical effectiveness and safety of a new flex-rigid pleuroscope.

Methods: A retrospective analysis of patients who were examined with a new flex-rigid pleuroscope under local anesthesia at our institution was conducted. Pleuroscopy was performed in 33 patients with undiagnosed exudative pleural effusions from December 2016 to March 2019.

Results: A total of 33 patients (10 women, 23 men); their median age 74 years (range 24-90) were investigated. Pleuroscopy showed that 18 had malignant pleural disease (54%), and 15 had benign pleural diseases (46%). The top three most frequent causes of pleural disease were pleural metastases of lung carcinoma (30.3%), pyothorax (15.1%), and malignant pleural mesothelioma (12.1%). In 32 cases (97%), observation at the introducer insertion site was possible. It was not possible in one case due to hard adhesions. The diagnostic rate was 100%, and the complication rate was 6.1%. There were no major complications, and minor complications included mild pain (one case) and minor bleeding (one case) that was stanched spontaneously.

Conclusions: The new flex-rigid pleuroscope is effective and safe for diagnosing pleural effusions. The improved bending angle is likely to minimize the blind area. The new pleuroscopy fiberscope may improve the diagnostic rate.

Keywords: LTF-Y0032; flex-rigid pleuroscope; pleural biopsy; pleural effusion.

FIGURE 1

The conventional pleuroscope (LTF‐240) with the inserted biopsy forceps directed fully upward (upper). The new pleuroscope (LTF‐Y0032) with the inserted biopsy forceps directed fully upward (lower)

FIGURE 2

The outer diameter of the LTF‐Y0032 pleuroscope is 7.3 mm, compared with the diameter of 6.9 mm of the LTF‐240. The internal diameter of the LTF‐Y0032 is 3.0 mm, compared with 2.8mm of the LTF‐240

FIGURE 3

Malignant mesothelioma (epithelial type). The unevenness is clearly visible, together with the visualization of irregular blood vessels with the LTF‐Y0032. A, Narrow‐band imaging demonstrates a bosselated lesion with a network of blood vessels B, Malignant lymphoma The LTF‐Y0032 more clearly demonstrated the nodule with a network of blood vessels C, Narrow‐band imaging demonstrates the presence of meandering blood vessels on the pleura and punctate vessels on the nodule (D)

FIGURE 4

Malignant mesothelioma (biphasic type). The LTF‐Y0032 is capable of observations at a maximum curvature of 180° when directed fully upward, enabling the observation of masses at the introducer insertion site and close to the introducer. Biopsy forceps are inserted and moved near the mass, which is close to the introducer (A). Pleural metastasis of lung carcinoma Observation of many nodules around the insertion site is possible (B). Pyothorax Curettage can be performed over a wide range (C)