Risk of bleeding associated with transbronchial biopsy using flexible bronchoscopy in patients with suspected pulmonary hypertension

Y. Takashima*^a (Dr), N. Shinagawa^a (Prof), D. Morinaga^a (Dr), J. Nakamura^a (Dr), M. Furuta^a (Dr), T. Shoji^a (Dr), H. Asahina^a (Dr), E. Kikuchi^a (Dr), J. Kikuchi^a (Dr), J. Sakakibara-Konishi^a (Dr), I. Tsujino^a (Prof), S. Konno^a (Prof)

^a Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, JAPAN

* y.takashima@huhp.hokudai.ac.jp

Background: The safety of endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) in patients with a finding of pulmonary hypertension (PH) is controversial. Little is known about the relationship between the risk of bleeding associated with EBUS-TBB in the presence of PH suspected on echocardiography or chest CT.

Methods: To assess the risk of bleeding associated with EBUS-TBB in patients with presumed PH per echocardiography or chest CT, we retrospectively reviewed the medical records of 314 consecutive patients who underwent EBUS-TBB using a guide sheath (GS), as well as echocardiography and chest CT. A bleeding complication was defined as over one minute of suctioning; repeated wedging of the bronchoscope; instillation of cold saline, diluted vasoactive substances, or thrombin due to persistent bleeding. PH was defined as peak tricuspid regurgitation velocity (TRV) > 2.8 m/s on echocardiography or pulmonary artery to aorta ratio (PA:A ratio) > 0.9 on chest CT.

Results: In total, 35 (11.1%) patients developed bleeding and all cases were managed safely. Furthermore, 17 (5.4%) and 59 (18.8%) patients were suspected to have PH based on echocardiography and chest CT, respectively. Of the patients suspected to have PH on echocardiography, 5 (5/17=29.4%) patients developed bleeding. Of the patients suspected to have PH on chest CT, 11 (11/59=18.6%) patients developed bleeding. Univariate analysis revealed that long diameter (≥ 30 mm) of the lesion, lesion location (biopsy site was inner side than segmental bronchus), bronchoscopic diagnosis of malignancy, and additional biopsy were potential predictive factors of bleeding. The finding of PH on echocardiography correlated significantly with bleeding (p =0.03). On multivariate analysis, long diameter of the lesion (p =.021) and finding of PH on echocardiography (p =.049) were significantly associated with bleeding.

Conclusion: PH suspected based on echocardiography may be a risk factor of significant but manageable bleeding associated with EBUS-TBB using a GS.

Disclosure of funding source(s): none