Dual-Scope Method: Enhancing Reliability of Hemostasis During Cryobiopsy

Background and Objective: Approximately 42% of patients encounter severe bleeding during transbronchial lung cryobiopsy, indicating a need to establish rapid and reliable hemostasis techniques. Although the conventional balloon occlusion and two-scope techniques have a certain degree of hemostatic effect, associated visual field obstruction and procedural complexity pose challenges. To address these issues, we developed the dual-scope hemostasis method, wherein therapeutic and ultrathin bronchoscopes are simultaneously inserted orally to reliably maintain hemostasis. In this study, we report our experience with the introduction of the “dual-scope method.” Materials and Methods: An ultrathin bronchoscope (BF-MP290F) was used for sampling, and a therapeutic bronchoscope (BF-1TH1200) was used for hemostasis. A balloon catheter (B5-2C) was inserted through the working channel of the ultrathin bronchoscope, and a single-use 1.1-mm cryoprobe (CRYO2) was used. Midazolam and fentanyl, as well as propofol when necessary, were administered for sedation; lidocaine 4% was sprayed as a local anesthetic. Results: The dual-scope method was applied to an 84-year-old man and a 55-year-old woman, and neither patient developed significant bleeding after the biopsy. In both cases, balloon placement in the target bronchus was smooth, and oxygenation was well maintained. Conclusion: The dual-scope method enabled rapid hemostasis under real-time observation, suggesting its superior safety and reliability. Further accumulation of cases and examination through multicenter collaborative studies are needed.