Safety and Utility of Outpatient Medical Thoracoscopy With Tunneled Pleural Catheter Insertion: A Canadian Experience.

SESSION TITLE: Pleural Disease PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PMPURPOSE: Medical Thoracosopy (MT) is a minimally invasive procedure which utilizes a flex-rigid pleuroscope in order to visualize the pleural space and perform biopsies for diagnostic purposes in patients with pleural disease. Many centers performing MT will insert a chest tube and admit patients to hospital after the procedure, which is less convenient for the patient, introduces risk of nosocomial infections, and creates additional health care costs. We hypothesized that MT can be performed safely and effectively in an outpatient setting by inserting a tunneled pleural catheter (TPC) after diagnostic biopsies are taken. We aimed to demonstrate safety and feasibility of this strategy in a large Canadian cohort.METHODS: We performed a retrospective review of prospectively collected data from all patients who underwent outpatient MT and TPC insertion for assessment of pleural disease between December 2007 and January 2014 at The Ottawa Hospital. Our outpatient protocol consisted of MT and TPC insertion performed under conscious sedation in the endoscopy unit. Chest x-rays were performed immediately post-procedure and one to two hours later. Patients without complications were discharged with analgesia, home care nursing follow-up and follow-up in the pleural diseases clinic. We collected data on patient demographics, disease characteristics and clinical outcomes which were subsequently analyzed.RESULTS: Outpatient MT and TPC insertion was performed in 283 patients during the study period. The most common indication for the procedure was an undiagnosed pleural effusion. Diagnostic yield was comparable to previously published results. Greater than 90% of patients were discharged the same day. There were very few complications and no procedure related mortality. Further data regarding short and longer term complication rates will be presented.CONCLUSIONS: Outpatient MT can be safely performed by interventional pulmonologists with experience in MT and in the setting of a comprehensive pleural disease program.CLINICAL IMPLICATIONS: This large study corroborates existing evidence that outpatient MT is a safe alternative to an inpatient surgical approach for undiagnosed pleural effusions.DISCLOSURE: The following authors have nothing to disclose: Robert Kyskan, Kayvan AmjadiNo Product/Research Disclosure Information.