Transbronchial Cryobiopsy – Is the bleeding risk changed in comparison to transbronchial forceps biopsy?

Background: Bronchoscopic cryobiopsy was recently introduced as tool for tissue sampling. In case of transbronchial biopsies, the obtained tissue is of high quality and represents lung parenchyma adequately for a histological diagnosis in most cases. Bleeding after transbronchial biopsy is the most relevant complication and may be life threatening. However it is unclear whether the extraction of larger tissue samples by cryobiopsy changes the risk of bleeding compared to transbronchial forceps biopsy. Methods: In this prospective, randomized, controlled multicenter study 370 patients with undiagnosed interstitial lung disease requiring bronchoscopic tissue sampling were included. Both, transbronchial forceps biopsy and transbronchial cryobiopsy were done in each patient. The sequence of the procedures was randomized. Results: In 370 patients 1245 cryobiopsies and 1340 forceps biopsies were performed. No bleeding was observed after forceps biopsy in 186 patients (50.3%) and in 100 patients (27.0%) after cryobiopsy. The rate of clinically relevant bleeding (moderate (need of any intervention) or severe (need of any intervention and prolonged monitoring after the bronchoscopy)) was higher after the cryobiopsy procedures compared to the forceps biopsies (15.9% vs. 4.1%, p Conclusions: Transbronchial cryobiopsy was associated with an increased risk of bleeding requiring interventional bleeding control. Therefore training for bleeding control and precautions such as ability for immediate tamponade should be taken.