Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Bronchoscopic cryotechniques in adults

Henri G Colt, MD
Section Editor
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD


Several bronchoscopic cryosurgical techniques are available that employ extremely low temperatures to freeze tissue for destruction (cryoablation), adhesion (cryoadhesion), or biopsy (cryobiopsy) [1-3]. The most common of these is cryoablation, a procedure that is mostly used to manage inoperable airway obstruction. The equipment, principles, techniques, indications, contraindications, and complications of these modalities are reviewed here. Other bronchoscopic techniques used to manage airway obstruction are described separately. (See "Clinical presentation, diagnostic evaluation, and management of central airway obstruction in adults" and "Endobronchial electrocautery" and "Endobronchial photodynamic therapy in the management of airway disease in adults" and "Bronchoscopic argon plasma coagulation in the management of airway disease in adults" and "Airway stents" and "Flexible bronchoscopy balloon dilation" and "Endobronchial brachytherapy".).


Bronchoscopic cryotechniques require a cryosurgery device (ie, cryoprobe or cryoforceps), bronchoscope, and cooling agent (ie, cryogen). Only experts skilled in the use of this equipment should perform cryosurgery (picture 1).

Cryosurgery device — Cryosurgery devices consist of a cryoprobe (ablative or adhesive procedures) or a cryoforceps (biopsy procedures), a transfer line, and a console. The cryoprobe/forceps is used to freeze the target tissue. The transfer line connects the cryoprobe/forceps to both the cooling agent storage container (eg, gas cylinder) and the console. The console controls the flow of cooling agent through the transfer line. (See 'Cryoablation' below and 'Cryoadhesion' below and 'Cryobiopsy' below.)

Cryoprobes may be rigid, semirigid, or flexible. Rigid cryoprobes have a system of reheating that induces a nearly immediate thaw phase, whereas thawing is a passive process with flexible cryoprobes, such that the freeze-thaw cycle is longer with the latter. Cryoforceps are typically flexible.

Bronchoscope — Rigid and semirigid cryoprobes can be used through a rigid bronchoscope only, whereas flexible cryoprobes and forceps can be used through either a flexible or a rigid bronchoscope. (See "Flexible bronchoscopy in adults: Overview" and "Rigid bronchoscopy: Instrumentation".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Apr 07, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Bolliger CT, Mathur PN, Beamis JF, et al. ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. Eur Respir J 2002; 19:356.
  2. Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004; 169:1278.
  3. Ernst A, Silvestri GA, Johnstone D, American College of Chest Physicians. Interventional pulmonary procedures: Guidelines from the American College of Chest Physicians. Chest 2003; 123:1693.
  4. Homasson, JP, Bell, NJ. Cryotherapy in chest medicine, Springer Verlag, Paris 1992.
  5. Noppen M, Meysman M, Van Herreweghe R, et al. Bronchoscopic cryotherapy: preliminary experience. Acta Clin Belg 2001; 56:73.
  6. Gage AA, Guest K, Montes M, et al. Effect of varying freezing and thawing rates in experimental cryosurgery. Cryobiology 1985; 22:175.
  7. Smith JJ, Fraser J. An estimation of tissue damage and thermal history in the cryolesion. Cryobiology 1974; 11:139.
  8. Miller RH, Mazur P. Survival of frozen-thawed human red cells as a function of cooling and warming velocities. Cryobiology 1976; 13:404.
  9. Gage AA, Caruana JA Jr, Montes M. Critical temperature for skin necrosis in experimental cryosurgery. Cryobiology 1982; 19:273.
  10. Rand RW, Rand RP, Eggerding FA, et al. Cryolumpectomy for breast cancer: an experimental study. Cryobiology 1985; 22:307.
  11. Rubinsky, B, Ikeda, M. A cryomicroscope using directional solidification for the controlled freezing of biological tissue. Cryobiology 1985; 22:55.
  12. Gilbert JC, Onik GM, Hoddick WK, Rubinsky B. Real time ultrasonic monitoring of hepatic cryosurgery. Cryobiology 1985; 22:319.
  13. Benson JW. Combined chemotherapy and cryosurgery for oral cancer. Am J Surg 1975; 130:596.
  14. Vergnon JM, Huber RM, Moghissi K. Place of cryotherapy, brachytherapy and photodynamic therapy in therapeutic bronchoscopy of lung cancers. Eur Respir J 2006; 28:200.
  15. Hetzel M, Hetzel J, Schumann C, et al. Cryorecanalization: a new approach for the immediate management of acute airway obstruction. J Thorac Cardiovasc Surg 2004; 127:1427.
  16. Prakash UB. Advances in bronchoscopic procedures. Chest 1999; 116:1403.
  17. Walsh DA, Maiwand MO, Nath AR, et al. Bronchoscopic cryotherapy for advanced bronchial carcinoma. Thorax 1990; 45:509.
  18. Maiwand MO, Homasson JP. Cryotherapy for tracheobronchial disorders. Clin Chest Med 1995; 16:427.
  19. Rodgers BM, Moazam F, Talbert JL. Endotracheal cryotherapy in the treatment of refractory airway strictures. Ann Thorac Surg 1983; 35:52.
  20. Mathur PN, Wolf KM, Busk MF, et al. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. Chest 1996; 110:718.
  21. Marasso A, Gallo E, Massaglia GM, et al. Cryosurgery in bronchoscopic treatment of tracheobronchial stenosis. Indications, limits, personal experience. Chest 1993; 103:472.
  22. Asimakopoulos G, Beeson J, Evans J, Maiwand MO. Cryosurgery for malignant endobronchial tumors: analysis of outcome. Chest 2005; 127:2007.
  23. Schumann C, Hetzel M, Babiak AJ, et al. Endobronchial tumor debulking with a flexible cryoprobe for immediate treatment of malignant stenosis. J Thorac Cardiovasc Surg 2010; 139:997.
  24. Ikekawa S, Ishihara K, Tanaka S, Ikeda S. Basic studies of cryochemotherapy in a murine tumor system. Cryobiology 1985; 22:477.
  25. Homasson JP, Pecking A, Roden S, et al. Tumor fixation of bleomycin labeled with 57 cobalt before and after cryotherapy of bronchial carcinoma. Cryobiology 1992; 29:543.
  26. Vergnon JM, Schmitt T, Alamartine E, et al. Initial combined cryotherapy and irradiation for unresectable non-small cell lung cancer. Preliminary results. Chest 1992; 102:1436.
  27. Forest V, Peoc'h M, Campos L, et al. Effects of cryotherapy or chemotherapy on apoptosis in a non-small-cell lung cancer xenografted into SCID mice. Cryobiology 2005; 50:29.
  28. Forest V, Peoc'h M, Ardiet C, et al. In vivo cryochemotherapy of a human lung cancer model. Cryobiology 2005; 51:92.
  29. Forest V, Peoc'h M, Campos L, et al. Benefit of a combined treatment of cryotherapy and chemotherapy on tumour growth and late cryo-induced angiogenesis in a non-small-cell lung cancer model. Lung Cancer 2006; 54:79.
  30. Le Pivert PJ, Binder P, Ougier T. Measurement of intratissue bioelectrical low frequency impedance: a new method to predict per-operatively the destructive effect of cryosurgery. Cryobiology 1977; 14:245.
  31. Bertoletti L, Elleuch R, Kaczmarek D, et al. Bronchoscopic cryotherapy treatment of isolated endoluminal typical carcinoid tumor. Chest 2006; 130:1405.
  32. Dalar L, Ozdemir C, Abul Y, et al. Endobronchial Treatment of Carcinoid Tumors of the Lung. Thorac Cardiovasc Surg 2016; 64:166.
  33. Eaton D, Beeson J, Maiwand O, Anikin V. Endoluminal cryotherapy in the management of endobronchial metastatic tumors of extrapulmonary origin. J Bronchology Interv Pulmonol 2015; 22:135.
  34. Nassiri AH, Dutau H, Breen D, et al. A multicenter retrospective study investigating the role of interventional bronchoscopic techniques in the management of endobronchial lipomas. Respiration 2008; 75:79.
  35. Maiwand MO, Zehr KJ, Dyke CM, et al. The role of cryotherapy for airway complications after lung and heart-lung transplantation. Eur J Cardiothorac Surg 1997; 12:549.
  36. Franke KJ, Nilius G, Rühle KH. [Cryorecanalization of an endobronchial lipoma]. Pneumologie 2005; 59:685.
  37. Taviot B, Coppere B, Pacheco Y, et al. [Tracheobronchial lipomatosis. Apropos of a case]. Rev Pneumol Clin 1987; 43:42.
  38. Sim JK, Choi JH, Oh JY, et al. Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy. Tuberc Respir Dis (Seoul) 2014; 76:141.
  39. Ucar N, Akpinar S, Aktas Z, et al. Resection of endobronchial hamartoma causing recurrent hemoptysis by electrocautery and cryotherapy. Hippokratia 2014; 18:355.
  40. Lee H, Leem CS, Lee JH, et al. Successful removal of endobronchial blood clots using bronchoscopic cryotherapy at bedside in the intensive care unit. Tuberc Respir Dis (Seoul) 2014; 77:193.
  41. Rojas-Tula DG, Gómez-Fernández M, García-López JJ, et al. Endobronchial cryotherapy for a mycetoma. J Bronchology Interv Pulmonol 2013; 20:330.
  42. Mu D, Nan D, Li W, et al. Efficacy and safety of bronchoscopic cryotherapy for granular endobronchial tuberculosis. Respiration 2011; 82:268.
  43. Bhora FY, Ayub A, Forleiter CM, et al. Treatment of Benign Tracheal Stenosis Using Endoluminal Spray Cryotherapy. JAMA Otolaryngol Head Neck Surg 2016; 142:1082.
  44. Samad I, Akst L, Karatayli-Özgürsoy S, et al. Evaluation of Dyspnea Outcomes After Endoscopic Airway Surgery for Laryngotracheal Stenosis. JAMA Otolaryngol Head Neck Surg 2016; 142:1075.
  45. Vonk-Noordegraaf A, Postmus PE, Sutedja TG. Bronchoscopic treatment of patients with intraluminal microinvasive radiographically occult lung cancer not eligible for surgical resection: a follow-up study. Lung Cancer 2003; 39:49.
  46. Schuurman B, Postmus PE, van Mourik JC, et al. Combined use of autofluorescence bronchoscopy and argon plasma coagulation enables less extensive resection of radiographically occult lung cancer. Respiration 2004; 71:410.
  47. Inoue M, Nakatsuka S, Jinzaki M. Cryoablation of early-stage primary lung cancer. Biomed Res Int 2014; 2014:521691.
  48. Krimsky WS, Broussard JN, Sarkar SA, Harley DP. Bronchoscopic spray cryotherapy: assessment of safety and depth of airway injury. J Thorac Cardiovasc Surg 2010; 139:781.
  49. Finley DJ, Dycoco J, Sarkar S, et al. Airway spray cryotherapy: initial outcomes from a multiinstitutional registry. Ann Thorac Surg 2012; 94:199.
  50. Browning R, Parrish S, Sarkar S, Turner JF Jr. First report of a novel liquid nitrogen adjustable flow spray cryotherapy (SCT) device in the bronchoscopic treatment of disease of the central tracheo-bronchial airways. J Thorac Dis 2013; 5:E103.
  51. Chudasama D, Rice A, Soppa G, Anikin V. Circulating tumour cells in patients with lung cancer undergoing endobronchial cryotherapy. Cryobiology 2015; 71:161.
  52. Homasson, JP. Bronchoscopic cryotherapy. J Bronchol 1995; 2:145.
  53. Homasson JP, Thiery JP, Angebault M, et al. The operation and efficacy of cryosurgical, nitrous oxide-driven cryoprobe. I. Cryoprobe physical characteristics: their effects on cell cryodestruction. Cryobiology 1994; 31:290.
  54. Rafanan AL, Mehta AC. Adult airway foreign body removal. What's new? Clin Chest Med 2001; 22:319.
  55. Weerdt S, Noppen M, Remels L, et al. Successful removal of a massive endobronchial clot by means of cryotherapy. Journal of Bronchology 2005; 12:23.
  56. Jabbardarjani R, Kiani A, Arab A. Nat Res Inst Tuberc and Lung Dis 2009; 8:60.
  57. Babiak A, Hetzel J, Krishna G, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration 2009; 78:203.
  58. Hetzel J, Hetzel M, Hasel C, et al. Old meets modern: the use of traditional cryoprobes in the age of molecular biology. Respiration 2008; 76:193.
  59. Franke KJ, Szyrach M, Nilius G, et al. Experimental study on biopsy sampling using new flexible cryoprobes: influence of activation time, probe size, tissue consistency, and contact pressure of the probe on the size of the biopsy specimen. Lung 2009; 187:253.
  60. Schumann C, Hetzel J, Babiak AJ, et al. Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions. J Thorac Cardiovasc Surg 2010; 140:417.
  61. Gershman E, Fruchter O, Benjamin F, et al. Safety of Cryo-Transbronchial Biopsy in Diffuse Lung Diseases: Analysis of Three Hundred Cases. Respiration 2015; 90:40.
  62. Hernández-González F, Lucena CM, Ramírez J, et al. Cryobiopsy in the diagnosis of diffuse interstitial lung disease: yield and cost-effectiveness analysis. Arch Bronconeumol 2015; 51:261.
  63. Griff S, Schönfeld N, Ammenwerth W, et al. Diagnostic yield of transbronchial cryobiopsy in non-neoplastic lung disease: a retrospective case series. BMC Pulm Med 2014; 14:171.
  64. Pajares V, Puzo C, Castillo D, et al. Diagnostic yield of transbronchial cryobiopsy in interstitial lung disease: a randomized trial. Respirology 2014; 19:900.
  65. Tomassetti S, Wells AU, Costabel U, et al. Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2016; 193:745.
  66. Segmen F, Aktaş Z, Öztürk A, et al. How many samples would be optimal for endobronchial cryobiopsy? Surg Endosc 2017; 31:1219.
  67. Hetzel J, Eberhardt R, Herth FJ, et al. Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial. Eur Respir J 2012; 39:685.
  68. Ganganah O, Guo SL, Chiniah M, Li YS. Efficacy and safety of cryobiopsy versus forceps biopsy for interstitial lung diseases and lung tumours: A systematic review and meta-analysis. Respirology 2016; 21:834.
  69. Dhooria S, Sehgal IS, Aggarwal AN, et al. Diagnostic Yield and Safety of Cryoprobe Transbronchial Lung Biopsy in Diffuse Parenchymal Lung Diseases: Systematic Review and Meta-Analysis. Respir Care 2016; 61:700.
  70. Johannson KA, Marcoux VS, Ronksley PE, Ryerson CJ. Diagnostic Yield and Complications of Transbronchial Lung Cryobiopsy for Interstitial Lung Disease. A Systematic Review and Metaanalysis. Ann Am Thorac Soc 2016; 13:1828.
  71. Ravaglia C, Bonifazi M, Wells AU, et al. Safety and Diagnostic Yield of Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Diseases: A Comparative Study versus Video-Assisted Thoracoscopic Lung Biopsy and a Systematic Review of the Literature. Respiration 2016; 91:215.
  72. Ravaglia C, Wells AU, Tomassetti S, et al. Transbronchial Lung Cryobiopsy in Diffuse Parenchymal Lung Disease: Comparison between Biopsy from 1 Segment and Biopsy from 2 Segments - Diagnostic Yield and Complications. Respiration 2017; 93:285.
  73. Ussavarungsi K, Kern RM, Roden AC, et al. Transbronchial Cryobiopsy in Diffuse Parenchymal Lung Disease: Retrospective Analysis of 74 Cases. Chest 2017; 151:400.