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New era of respiratory endoscopy
respiratory investigation 54 (2016) 223
Contents lists available at ScienceDirect
Respiratory Investigation journal homepage: www.elsevier.com/locate/resinv
Editorial
New era of respiratory endoscopy This year is the 50th anniversary after a flexible bronchoscope was developed in 1966 by Dr. Shigeto Ikeda. The bronchoscope has since been improved, and a brighter electronic scope with better resolution has been developed. The outer diameter of the bronchoscope has become thinner, and improvements have been made to the model, making it easier to handle. Although various interventional techniques have also been developed, these seemed to be too little in comparison with the progress in the gastrointestinal area. Over the past few years, progress in bronchoscopy for the treatment of the medical diseases, including treatment of severe asthma with bronchial thermoplasty [1] and treatment of the pulmonary emphysema using a bronchial valve [2] has been remarkable. In the diagnostic field, precision for small peripheral lung lesions that are invisible under X-ray, has been achieved by confirming arrival at the lesion by means of a radial-type ultrasound probe and silicone guide sheath [3]. Furthermore, development of the convex-type ultrasound probe has allowed easy and precise diagnosis of target lesions adjacent to trachea or bronchus [4]. In addition, the development of a navigation system has made it easy to find the needle in the haystack, and thus the diagnostic yield of small peripheral lung lesions has been greatly improved. In the current issue of this journal, the recent advances in respiratory endoscopy are featured. Asano [5] has reviewed the utility of a radial-type endobronchial ultrasound (EBUS) probe and a virtual navigation system for the diagnosis of small peripheral lung lesions. This approach, using a guide sheath and EBUS, has expanded the use of this essential tool for diagnosis of lung cancer into clinical practice. By using an EBUS probe with a guide sheath (EBUS-GS), the lesion can be biopsied through the guide sheath after confirmation that the probe has reached the lesion. Furthermore, in this issue, Nakajima et al. [6] have reviewed the usefulness of transbronchial needle aspiration biopsy (TBNA) using a convextype EBUS. This has certainly improved the pathological diagnostic yield of lymph nodes and masses adjacent to the trachea or bronchus. Another article in this issue, by Miyazawa et al. [7], reviews choke point physiology in airway stenting. They show that analysis of the choke point in cases with airway stenosis is useful to decide on effective stent positioning.
The accumulation of studies and clinical experience in respiratory endoscopy over the past 50 years has led to a steady advance in medicine. This has laid the foundation for a new era of further development in respiratory endoscopy.
Yoshiki Ishii, MD, PhD Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Japan
r e f e r e nc e s
[1] Castro M, Rubin AS, Laviolette M, et al. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, shamcontrolled clinical trial. Am J Respir Crit Care Med 2010;181:116–24. [2] Davey C, Zoumot Z, Jordan S, et al. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi study): a randomised controlled trial. Lancet. 2015;386:1066–73. [3] Kurimoto N, Miyazawa T, Okimasa S, et al. Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. Chest 2004;126:959–65. [4] Yasufuku K, Chiyo M, Koh E, et al. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer 2005;50:347–54. [5] Asano F. Advanced bronchoscopy for the diagnosis of peripheral pulmonary lesions. Respir investing 2016;54:224–9. [6] Nakajima T, Yasufuku K, Fujiwara T, et al. Recent advances inendobronchial ultrasound-guided transbronchial needle aspiration. Respir investing 2016;54:230–6. [7] Miyazawa T, Nobuyama S, Nishine H, et al. Choke point physiology in airway stenting: A case presentation and discussion. Respir investing 2016;54:237–40.
http://dx.doi.org/10.1016/j.resinv.2016.06.003 2212-5345/& 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.
Contents lists available at ScienceDirect
Respiratory Investigation journal homepage: www.elsevier.com/locate/resinv
Editorial
New era of respiratory endoscopy This year is the 50th anniversary after a flexible bronchoscope was developed in 1966 by Dr. Shigeto Ikeda. The bronchoscope has since been improved, and a brighter electronic scope with better resolution has been developed. The outer diameter of the bronchoscope has become thinner, and improvements have been made to the model, making it easier to handle. Although various interventional techniques have also been developed, these seemed to be too little in comparison with the progress in the gastrointestinal area. Over the past few years, progress in bronchoscopy for the treatment of the medical diseases, including treatment of severe asthma with bronchial thermoplasty [1] and treatment of the pulmonary emphysema using a bronchial valve [2] has been remarkable. In the diagnostic field, precision for small peripheral lung lesions that are invisible under X-ray, has been achieved by confirming arrival at the lesion by means of a radial-type ultrasound probe and silicone guide sheath [3]. Furthermore, development of the convex-type ultrasound probe has allowed easy and precise diagnosis of target lesions adjacent to trachea or bronchus [4]. In addition, the development of a navigation system has made it easy to find the needle in the haystack, and thus the diagnostic yield of small peripheral lung lesions has been greatly improved. In the current issue of this journal, the recent advances in respiratory endoscopy are featured. Asano [5] has reviewed the utility of a radial-type endobronchial ultrasound (EBUS) probe and a virtual navigation system for the diagnosis of small peripheral lung lesions. This approach, using a guide sheath and EBUS, has expanded the use of this essential tool for diagnosis of lung cancer into clinical practice. By using an EBUS probe with a guide sheath (EBUS-GS), the lesion can be biopsied through the guide sheath after confirmation that the probe has reached the lesion. Furthermore, in this issue, Nakajima et al. [6] have reviewed the usefulness of transbronchial needle aspiration biopsy (TBNA) using a convextype EBUS. This has certainly improved the pathological diagnostic yield of lymph nodes and masses adjacent to the trachea or bronchus. Another article in this issue, by Miyazawa et al. [7], reviews choke point physiology in airway stenting. They show that analysis of the choke point in cases with airway stenosis is useful to decide on effective stent positioning.
The accumulation of studies and clinical experience in respiratory endoscopy over the past 50 years has led to a steady advance in medicine. This has laid the foundation for a new era of further development in respiratory endoscopy.
Yoshiki Ishii, MD, PhD Department of Pulmonary Medicine and Clinical Immunology, Dokkyo Medical University School of Medicine, Japan
r e f e r e nc e s
[1] Castro M, Rubin AS, Laviolette M, et al. Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, shamcontrolled clinical trial. Am J Respir Crit Care Med 2010;181:116–24. [2] Davey C, Zoumot Z, Jordan S, et al. Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi study): a randomised controlled trial. Lancet. 2015;386:1066–73. [3] Kurimoto N, Miyazawa T, Okimasa S, et al. Endobronchial ultrasonography using a guide sheath increases the ability to diagnose peripheral pulmonary lesions endoscopically. Chest 2004;126:959–65. [4] Yasufuku K, Chiyo M, Koh E, et al. Endobronchial ultrasound guided transbronchial needle aspiration for staging of lung cancer. Lung Cancer 2005;50:347–54. [5] Asano F. Advanced bronchoscopy for the diagnosis of peripheral pulmonary lesions. Respir investing 2016;54:224–9. [6] Nakajima T, Yasufuku K, Fujiwara T, et al. Recent advances inendobronchial ultrasound-guided transbronchial needle aspiration. Respir investing 2016;54:230–6. [7] Miyazawa T, Nobuyama S, Nishine H, et al. Choke point physiology in airway stenting: A case presentation and discussion. Respir investing 2016;54:237–40.
http://dx.doi.org/10.1016/j.resinv.2016.06.003 2212-5345/& 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.