Volume 06
Issue 03
September 2018
Inside This Issue
Opinion/Editorial, 2
Technology Corner, 3,4
Tips from the Experts, 5,6
Humanitarian News, 7,8,9
Educaon and Training, 10
WABIP News, 11, 12
Research, 13, 14
Special News, 15-18
WABIP Academy Webcasts, 19
Links, 19
Upcoming Events, 20,21
da that allow all the aendees to
create new friendship, learn in
the most smulang way and
know the history and the past
and present of one of the most
famous medical instuons in
the world.
We are sure that all the Congress
aendees share the same gra-
tude the WABIP-WCBE leader-
ship expresses for such a suc-
cessful conference and such a
fantasc opportunity to meet
our colleagues all over the world
bringing back home the warmest
memories and a renewed enthu-
siasm to keep on working for the
development of bronchoscopy in
each one of our countries.
Silvia Quadrelli, MD
Buenos Aires, Argenna
Vice-chair, WABIP
Every other year, the World Con-
gress Joint Meeng of the World
Associaon for Bronchology and
Intervenonal Pulmonology
(WABIP) & The Internaonal
Bronchoesophagological Society
(IBES) 2018 provides internaonal
parcipants unmatched opportu-
nies to exchange scienc ideas
& research in bronchology and
intervenonal pulmonology. This
World Congress is a unique forum
for physician’s, new technology
developers, academic researchers
and end users to share the latest
advances in bronchoscopy tech-
niques and their applicaons in
human health.
This year, the 20th WCBIP/WCBE
World Congress WABIP & IBES
has been held in Rochester, MN
US in June 13-16, 2018 and has
not been the excepon of this
long tradion of academic ex-
change. Experts from all over the
world discussed during 3 days
wide topics from the role of new
technologies (like cryobiopsy,
thermoplasty, endoscopic ultra-
sound) to the management of the
most relevant tracheal, bronchial
and pulmonary parenchymal dis-
eases. Tracheoesophageal stulas,
lung cancer, obstrucve lung dis-
ease, lung nodules, intersal
lung diseases or tuberculosis were
studied from the perspecve of
dierent countries and bringing
management opons for the
dierent contexts and the dier-
ent availability of technology. Di-
dacc lectures, interacve ses-
sions and expert panel discussions
allowed to discuss the newest
ndings in airway diseases. Hands
-on workshops gave the oppor-
tunity to pracce the dierent
intervenonal procedures guided
by experts in bronchoscopy edu-
caon.
The excellent conference venue
oered by the Mayo Civic Centre
was the perfect scenario for this
internaonal conference. The am-
ple and comfortable facilies, ide-
al for educaonally focused
events as our World Congress cre-
ated a wonderful ambiance to
exchange ideas, discuss scienc
trends, and explore soluons to
the old and new challenges in
bronchology.
The 20
th
WCBIP Congress Presi-
dent (Eric Edell) and the WCBE
President (Dr. Jan Kasperbauer)
did a wonderful job that sur-
passed all the expectaons. A
complete and varied academic
program, an outstanding organi-
zaon and a fabulous social agen-
Guest Opinion/Editorial
WABIP Newsletter
S E P T E M B E R 2 0 1 8 V O L U M E 6 , I S S U E 3
EXECUTIVE BOARD
Silvia Quadrelli MD
Buenos Aires,
Argenna, Chair
Hideo Saka MD
Nagoya, Japan,
Vice-Chair
Zsolt Papai MD
Székesfehérvár,
Hungary, Immediate
Past-Chair
David Fielding MD
Brisbane Australia,
Treasurer
Guangfa Wang MD
Beijing, China,
President WCBIP 2020
Philip Astoul, MD
Marseille, France,
President WCBIP 2022
STAFF
Michael Mendoza
General Manager
Judy McConnell
Administrator
Kazuhiro Yasufuku
Newsleer Editor-in-
chief
P A G E 2
World Congress Joint Meeng of the World Associaon for Bronchology and
Intervenonal Pulmonology (WABIP) & The Internaonal
Bronchoesophagological Society (IBES) 2018
Technology Corner
Near-infrared imaging during VATS with transbronchial injecon of ICG
Yasuo Sekine, MD, PhD
Professor, Department of Thoracic Surgery
Tokyo Women’s Medical University Yachiyo Medical Center
Introducon: Recent advances in CT screening has resulted in the increase of early stage lung cancer detecon, specically small
peripheral lung cancer. Various methods of intraoperave localizaon of such small nodules during minimally invasive surgery have
been reported. Furthermore, pulmonary sublobar resecon has been recognized as an operave opon for complete resecon of
these early stage lung cancers [1] and metastac lung tumors. Sublobar resecon is ideal for preservaon of lung parenchyma,
pulmonary funcon, with lower perioperave morbidies and can be applied for surgical manage; ; @L - H< < @ < 1">dional primary lung
cancers that may develop afgter inial resecon. Recent surgical topics in lung neoplasms are how to manage a non-palpable small
nodule in the peripheral or intermediate poron and how to maintain adequate surgical margins during sublobar resecon. To
answer these quesons, the establishment of precise tumor marking method as well as anatomical sublobar resecon with meas-
urable surgical margin is crucial.
Background: The standard approach for anatomical lung segmentectomy is vascular and bronchial transecons followed by divi-
sion of intersegmental planes. However, this method has several obstacles especially in complex segmental resecon. The iden-
caon of segmental bronchus and associated vessels is somemes dicult and intraoperave inaon of the lung can be a chal-
lenge during thoracoscopic surgery. Although the conrmaon of an appropriate resecon margin from the tumor is crucial for
reducing the risk of local recurrence [2], there has been no reliable method of measurement.
The common methods for localizaon of small sized pulmonary nodules are microcoil or hook wire implantaon and dye marking
by CT guidance or transbronchial inseron. However, these methods are somemes me consuming, technically challenging, may
require high cost and may induce rare but severe complicaons.
We previously developed and reported a novel approach for performing segmentectomy by using a Near-infrared thoracoscopy
with transbronchial insllaon of indocianine green (ICG) [C]. We improved this method by combining with the most advanced
computer technology of making virtual sublobar resecons and established a precise anatomical sublobar resecon with enough
surgical margin. This method can also serve both as tumor localizaon marking and anatomical super deep wedge resecon for
early stage lung cancers and metastac lung tumors.
Clinical applicaons: There are two types of ICG idencaon in ICG-guided segmentectomy [3,4]. One is negave staining by
intravenous injecon of ICG aer pulmonary arterial division [3]. The other is posive staining by transbronchial insllaon of ICG
before operaon [4]. The surgical step of negave staining is basically the same with tradional approach, vascular and bronchial
transecon followed by segmental division aer ICG i.v. injecon. On the other hand, posive staining is simultaneous process of
vascular and bronchial division and segmental division because of possible inial idencaon of segmental planes.
In negave staining, aer vascular and bronchial divisions, 0.25 mg/kg of ICG is intravenously injected. Soon aer injecon, ICG
uorescence is visualized in circulated area. Therefore, ischemic area, which is the segments to be resected, is not stained. Alt-
hough this condion connues for only 60 to 90 seconds because of quick circulatory distribuon, ICG injecon can be done re-
peatedly.
In posive staining, before operaon, virtual segmentectomy is created by using a 3D-CT volume analyzer and appropriate area of
segmentectomy is decided based on surgical margin (Fig. 1). Under general anesthesia, 10ml of 10-fold diluted ICG is inslled into
each associated bronchus. ICG is connuously remained in the segmentectomy area. ICG staining connues for several hours.
Therefore, we can conrm resecon area at any me during operaon and conrm vessels and bronchus to be divided (Fig. 2).
W A B I P N E W S L E T T E R
P A G E 3
Furthermore, we created anatomical super deep wedge resecon by ICG uorescence system. When the tumor is very small and deep from
the lung surface, it is impossible to palpate. The surface marking may not be eecve because the depth cannot be speculated. In these
cases, virtual sublobar resecon is created in order that the nodule is placed in the center of simulated resecon area (Fig. 3). Then, ICG is
inslled in the same manner. Anatomical deep lung wedge resecon is possible by dividing the lung along the ICG borderline without indi-
vidual vascular transecon with enough surgical margin (Fig. 4). In parcular, this procedure can conrm central surgical margin, because
all removal area is displayed by uorescence.
Conclusion: Transbronchial ICG insllaon and ICG-guided sublobar resecon is feasible for early stage lung cancers and metastac lung
tumors. This method can be applied to tumor localizaon and is also useful for assuring good surgical margin during complex sublobar re-
secons.
References
1. Landreneau et al. J Clin Oncol. 2014; 32(23): 2449-55
2. Sawabata N. Gen Thorac Cardiovasc Surg. 2013; 61(1): 9-16
3. Mun et al. J Vis Surg. 2017 Jun 7; 3: 80
4. Sekine et al. J Thorac Cardiovasc Surg 2012; 143(6): 1330-5
W A B I P N E W S L E T T E R P A G E 4
Figure 1: Virtual 3D image of right S1+S2a+S3bi segmentectomy.
There are two nodules in the right upper lobe at S2a and S3b in
paents with metastac lung tumor from renal leiomyosarcoma.
Figure 2: Actual image of ICG-guided segmentectomy which completely
matches with a virtual image.
Figure 3: Virtual 3D image of anatomical super deep wedge resecon (ASDWR). The
nodule is located in S1+2cii and S3ai. To obtain enough margin, S4ai is added. This bron-
chus is a sixth bronchial bifurcaon counng from the carina.
Figure 4: Actual image of ICG-guided ASDWR which
completely matches with a virtual image. This pro-
cedure is useful as a tumor localizaon marking.
Tips from the Experts
P A G E 5 V O L U M E 6 , I S S U E 3
Since Myrvik’s 1961 described technique for obtaining pulmonary macrophages from rabbit lungs and Reynolds and Newball’s 1974 descrip-
on of a ‘liquid lung biopsy’ described as bronchoalveolar lavage (BAL) in normal healthy subjects and paents with various intrathoracic
lesions, BAL has been used to assess inammaon in paents with lung infecons, cancer, exposure to toxic substances, asthma, and chron-
ic obstrucve pulmonary disease, as well as to support or exclude causes of alveolis, monitor the status of lung allogras, help diagnose
illnesses such as hisocytosis, pulmonary alveolar proteinosis, peripheral lung cancer, asbestos-related lung disease, and berylliosis, and
monitor uid cell dierenals in paents with intersal lung disease. Furthermore, translaonal research studies of BAL uid, including
studies of surfactant, inammatory proteins, cellular dierenals, serum molecules and proteomics/gene expression have increased our
understanding of lung inammaon and pulmonary injury/repair processes in adults and children. In both healthy individuals and paents,
BAL ndings are inuenced by degree of atopy, age, smoking status and underlying pulmonary condions (1).
Because alteraons in BAL uid and cells reect alteraons in lung parenchyma, careful aenon must also be paid to sampling procedures,
specimen processing, and precise analysis of cell dierenals. Numerous techniques for BAL have been described, although all follow a few
general guidelines. The goal of the procedure is to sample the largest target area possible by wedging a exible bronchoscope into a distal
airway, inslling several aliquots of isotonic saline soluon (warmed to room temperature) in a way that ‘oods” target bronchial and bron-
chioloalveolar territories, and retrieving that uid for analysis without contaminang the specimen with an overabundance of squamous
bronchial epithelial cells (of which there should be less than 4 percent per specimen). Ideally, BAL uid should contain solute and cells that
reect the underlying pathophysiologic disease process. The locaon for sampling is dependent upon the clinical indicaons, with most op-
erators reporng decreased yield from gravity dependent lower lobes, and maximum yields from the middle lobe or lingula, even in paents
with diuse lung disease. In paents with focal disease, target regions can be idened based on careful review of high-resoluon comput-
ed tomography scans.
Various methods for determining BAL insllaon volume have also been described and adjusng the amount of inslled volume (per weight
of the subject) has been proposed at least in children. Quanes inslled may vary based on clinical seng and insllaon technique, as
well as on underlying disease or normality and insllaon protocols (2). Technique is important because studies have shown that many fac-
tors can inuence the quality and composion of BAL samples, including the volume of saline inslled and the length of dwell me between
insllaon and withdrawal. Most operators today recommend techniques within or close to the framework provided in guidelines such as
one published by the American Thoracic Society (3), including clear wedging of the exible bronchoscope in the target bronchopulmonary
segment, inslling more than 100cc but less than 300cc of isotonic saline soluon, and using 3-5 sequenally inslled aliquots via a
handheld syringe (although some operators insll via tubing). Fluid is retrieved by gentle sucon that can be performed using the syringe, or
by using the sucon channel of the bronchoscope (wall sucon should probably be reduced to between 60 mm and 100 mm). In both in-
stances it is oen possible to watch the stream of air bubbles as uid is aspirated (See Figure 1).
Sucon should be applied such that airway walls do not collapse completely. It is generally accepted that the rst aliquot of at least 20 ml
will contain mostly bronchial cells and protein, and for this reason many operators will discard the rst aliquot in cases of intersal lung
disease and when BAL is done for research purposes or any indicaons other than presumed infecon or malignancy. Recall that bron-
choalveolar lavage (many experts say the procedure should really be called bronchioloalveolar lavage) samples a distal bronchoalveolar ter-
ritory and is therefore dierent from a bronchial wash. To maximize uid return, some operators me uid insllaon and aspiraon with
the paent’s respiratory eorts. Others insist on dwell mes of at least a few seconds venturing up to 20 seconds. Regardless of details,
most authors report a BAL uid return of more than 10 percent of the amount inslled (and ideally closer to 40 or 50 percent) as necessary
to be considered sasfactory and reliable (4).
BRONCHOALVEOLAR LAVAGE
Henri Colt MD, FAWM
Professor Emeritus, University of California, Irvine
henricolt@gmail.com
Tips from the Experts
P A G E 6 V O L U M E 6 , I S S U E 3
Figure 1: BAL uid insllaon aer wedging the exible bronchoscope into the distal bronchus. Bubbling is noted along with a patent air-
way during gentle sucon and uid retrieval (note absence of airway wall collapse). From Colt HG, www.Bronchoscopy.org (hps://
www.bronchoscopy.org/ppt-art/AB-2A/AB-2a.ppt).
In conclusion, many papers describing BAL in healthy and diseased paents report a variety of dierent techniques, but follow a few general
rules such as: selecng the target region using computed tomography, gradual insllaon of a set amount of uid using several aliquots, gen-
tle sucon of uid in a way that avoids airway wall collapse, avoiding bronchial epithelial cell contaminaon of specimens, and separang
samples into site-specic sterile containers dependent on the needs and preferences of the instuon’s laboratory and depending on tests
requested (cytology, proteomics, cell counts and dierenals, T-cell subtyping and other phenotypic stains, immunology, microbiology etc..)
(5). Sending less than 15 cc of BAL uid to the laboratory is not recommended because such samples usually contain a low number of cells
and thus may be unreliable. In my opinion, while BAL techniques are varied across countries and across medical instuons, procedures
should be standardized as best possible, and performed in a uniform manner by bronchoscopy teams within an instuon aer consultaon
with laboratory personnel, dependent of course on logiscs, medical experse, needs, and indicaons for the procedure. It goes without say-
ing that paents should be monitored for BAL-related adverse events, which although infrequent, include transient or delayed hypoxemia,
bronchospasm, pneumothorax, and bacteremia. Readers may refer to a multude of review papers, book chapters, and scienc studies for
informaon about indicaons, contraindicaons, precauons in select populaons, ethics of performing the procedure especially in the re-
search seng or in healthy subjects, complicaons, specimen handling, uid processing and analysis, and other step-by-step descripons/
guidelines/summaries of BAL procedural techniques.
References:
1. Heron et al. Clin Exp Immunol.2011;167:523-31.
2. Radhakrishnan et al. Pediatrics 2014;134-54.
3. Meyer et al. Am J Respir Crit Care Med 2012;185:1004-14.
4. Baughman RP. J Bronchol 2003;10:309-14.
5. Collins et al. Video Arcle, J Vis Exp 2014;85:e4345 pgs 1-6.
Humanitarian News
W A B I P N E W S L E T T E R P A G E 7
The dierent actors of the humanitarian world: The Internaonal Commiee of Red
Cross
The InRed Cross (ICRC), was established in 1863. Its mission is to work worldwide to ensure hu-
manitarian protecon and assistance for people aected by conict and armed violence. Their acvies are launched in re-
sponse to emergencies and with the main commitment of assuring the respect for internaonal humanitarian law. It is an
independent and neutral organizaon, whose mandate is based on the Geneva Convenons of 1949.
The group that was going to become the Internaonal Commiee of the Red Cross met for the rst me in February 1863 in
Geneva, Switzerland. One of the ve members was a Swiss named Henry Dunant authot of a recent published book named
“A Souvenir of Solferino”.
The Bale of Solferino had taken place on 24 June 1859 resulng in the victory of the Napolean French Army and Sardinian
Army against the Austrian Army. The bale was a parcularly brush one, and resulted in more than 2000 Austrian troops
killed and more than 10.000 wounded. There were reports of wounded and dying soldiers being shot on both sides, congur-
ing a parcular horrifying war scenario. Jean-Henri Dunant, who (being there for a business trip) witnessed the aermath of
the bale in person, was movated by the horric suering of wounded soldiers le on the baleeld and started social and
polical advocacy against the cruelty in war, a campaign that would eventually result in the Geneva Convenons and the
establishment of the Internaonal Red Cross. Dunant could witness the thousand wounded, dying and dead remained on the
baleeld, and the absence of any aempt to provide care. He was shocked, and organized the civilian populaon, especial-
ly the women and girls, to provide assistance to the injured and sick soldiers. Most importantly, he convinced the populaon
to service the wounded without regard to their side in the conict under the moo "Tu fratelli" (All are brothers). His ideas
were the basis of the 1864 Geneva Convenon. In 1901 he received the rst Nobel Peace Prize together with Frédéric Passy.
Dunant and his colleagues got to meet government representaves to agree on Dunant's proposal for naonal relief socie-
es, to help military medical services to provide medical care. Aerwards, they convinced governments to adopt the rst
Geneva Convenon, obliging armies to care for wounded soldiers, whatever side they were on. The Red Cross on a white
background became the emblem of this new unied neutral medical services.
Currently, the work of the ICRC is based on the Geneva Convenons of 1949, their Addional Protocols, its Statutes – and
those of the Internaonal Red Cross and Red Crescent Movement – and the resoluons of the Internaonal Conferences of
the Red Cross and Red Crescent. The ICRC is an independent, neutral organizaon ensuring humanitarian protecon and
assistance for vicms of armed conict and other situaons of violence.
The ICRC's primary role was a coordinang one. But it gradually became more involved in eld operaons, as the need for a
neutral intermediary between belligerents showed to be increasingly important .
The acon of the ICRC is based on 7 fundamental principles: Humanity, imparality, neutrality, independence, voluntary ser-
vice, unity and universality. Those principles provide the ethical, operaonal and instuonal framework to the work of the
Red Cross and Red Crescent Movement.
Adherence to these principles ensures the humanitarian nature of the Movement's work and gives the thical framework for
its acvies around the world.
Humanitarian News
W A B I P N E W S L E T T E R P A G E 8
The ICRC is a mul-state organizaon because it is funded by voluntary contribuons from the States party to the Geneva
Convenons (governments); naonal Red Cross and Red Crescent sociees; supranaonal organizaons (such as the Europe-
an Commission); and public and private sources. That is a dierent structure and prole that the one of the internaonal
humanitarian NGOs. A non-governmental organizaon (NGO), or "civil society organizaon" is a not-for-prot group, princi-
pally independent from government, which is organized on a local, naonal or internaonal level to address issues in sup-
port of the humanitarian aid. There are usually task-oriented (health, educaon, human rights, housing, etc.) and made up of
people with a common interest. The NGOs give direct services and humanitarian funcons, but also have a strong task of
advocacy (depending on each organizaon) bringing public concerns to governments, monitoring policy and program imple-
mentaon, and engaging the civil society in the direct acon.
This dierenaon is essenal and clearly established by the Sphere Project: NGOs (Non-Governmental Organizaons) refers
to organizaons, both naonal and internaonal, which are constuted separately from the government of the country in
which they are founded. That is dierent from the NGHAs: (Non-Governmental Humanitarian Agencies) that include the
components of the Internaonal Red Cross and Red Crescent Movement - The Internaonal Commiee of the Red Cross,
The Internaonal Federaon of Red Cross and Red Crescent Sociees and its member Naonal Sociees - and the NGOs as
dened above. A dierent category are the IGOs (Inter-Governmental Organizaons) name that refers to organizaons con-
stuted by two or more governments. It thus includes all United Naons Agencies and regional organizaons.
This dierences between NGOs an mul-government agencies are reected in the dierent mandates they work on. The
legal mandates of internaonal agencies working in humanitarian operaons are of two main types: state-mandated or self-
mandated. United Naons organizaons, like UNHCR, UNICEF, UN WFP, UN WHO and UN OCHA, have internaonal man-
dates that are legally recognized by states. So too do the Internaonal Commiee of the Red Cross (ICRC), the Internaonal
Federaon of Red Cross and Red Crescent Sociees, Naonal Red Cross/Crescent Sociees and the Internaonal Organiza-
on for Migraon (IOM). These agencies can be described as state-mandated. All other agencies – largely NGOs and CBOs -
tend to be self-mandated as voluntary organizaons set up as private iniaves seeking public support. Self-mandated agen-
cies are usually registered, recognized and regulated by states to diering degrees but do not carry a formal internaonal
mandate. This rst sense of the term mandate reects an idea of internaonal legimacy grounded in the power of either
states or civil society.
As clearly marked by Steven Ratner, “The ICRC thus represents a sui generis enty in the internaonal legal process. Its sta-
tus under Swiss law as a private associaon makes it akin to an NGO. The role of states in the Movement and the interna-
onal conferences that guide some of the ICRC’s work, the funding by governments, and the ICRC’s image through its dele-
gaons resemble the workings of an internaonal organizaon. Its close es to Switzerland – its locaon, the naonality of
Commiee members and senior sta, and frequent contacts with the Swiss Foreign Ministry18 – give it a prole unique
among internaonal organizaons and NGOs; and the ICRC clearly benets from Switzerland’s reputaon of neutrality in
internaonal aairs. Governments and armed groups suspicious of the moves of NGOs based in the United Kingdom, the
United States, or France will be less likely to aack the moves of the ICRC”.
Even when their relaon with the dierent governments and their source of funds give each one of those categories very
dierent proles and responsibilies in front of their funders, all of them share the Code of Conduct that must rule the acv-
ies of any humanitarian organisaon. The rst and main component of the Code of Conduct is: The Humanitarian impera-
ve comes rst. This means that the right to receive humanitarian assistance, and to oer it, is a fundamental humanitarian
principle which should be enjoyed by all cizens of all countries. As members of the internaonal community, the humani-
Humanitarian News
W A B I P N E W S L E T T E R P A G E 9
tarian actors recognise their obligaon to provide humanitarian assistance wherever it is needed which requires unimpeded
access to aected populaons as a fundamental component of that responsibility. The prime movaon is to alleviate hu-
man suering and no polical movaon should be included in their choices.
The humanitarian imperave (according to UNICEF) means that “human suering must be addressed wherever it is found,
with parcular aenon to the most vulnerable in the populaon. The dignity and rights of all those in need of humanitarian
assistance must be respected and protected”. The humanitarian imperave implies a right to receive humanitarian assis-
tance and a right to oer it. At mes, humanitarian access to civilian populaons is denied by authories for polical or secu-
rity reasons. Humanitarian agencies must maintain their ability to obtain and sustain access to all vulnerable populaons and
to negoate such access with all pares to the conict.
In spite of some apparently clear mandates and denions, humanitarian acon is currently challenged by many evolving
and changing pracce in warfare. New geo-polical tensions and some more classical problems of neutrality, protracon and
relief ethics make humanitarian policy and pracce more and more dicult in the current mes. Managing these tensions
requires constant and prudenal judgement by the dierent humanitarian actors. But the humanitarian aid all over the
world requires the connuous support of the civil sociees and the understanding of their responsibility in monitoring the
respect of internaonal law by their States, a responsibility that civilian and ordinary cizens cannot delegate.
*The views expressed in this arcle are those of the author and do not necessarily reect the ocial posions of the Execu-
ve Board or Internaonal Board of Regents of the WABIP. Dr. Silvia Quadrelli is Vice-chair of the WABIP.
An overview of Bronchoscopy Practises in the UK
Dr Syed Arshad Husain FRCP (Glasgow), FCCP (USA)
Consultant Respiratory Physician MTW NHS Trust, Honorary Senior Clinical
Lecturer Kings College London, WABIP member Board of Regents for UK
Bronchoscopy remains a very important invesgave tool used by Respiratory Physicians in almost all centres in UK providing Respiratory Med-
icine services, an approximate esmate of about 450-500 Respiratory Physicians would be performing Bronchoscopies around the UK
Bronchoscopy lists are usually 1-2 in the week in each centre, usually done in a dedicated Edoscopic suite and the paent is given sedaon with
Midazolam on an average between 2-3 milligrams, very occasionally paents with low or borderline saturaons would be done without seda-
on. Lignocaine Nasal or Oral spray is oen used, Lignocaine 1%, 6-8 millilitres via syringe for the vocal cords and similar amounts for the carina
and Right and Le main Bronchus used. Most centres would have Pulse Oximetry, ECG and Blood Pressure monitoring throughout the proce-
dures. Most performers would do from the back of the paents but 40-45 % Bronchoscopists would do it from the front and nasal route as op-
posed to oral route
With the advent of Linear Endobronchial Ultrasound (EBUS) Trans bronchial Needle Aspiraon (TBNA) biopsies the number of Bronchoscopies
have been reduced, but almost one in four Respiratory set up around UK are using Linear EBUS for diagnoscs in Lung cancer diagnosis by biop-
sying the Mediasnal Lymph Nodes. So the approach is usually Hit and Run for diagnosc reasons but some would also do complete staging as
well as diagnoscs for Lung cancer and other cancers causing Mediasnal Lymph Node enlargement. Only few centres would have lists under
General Anaesthesia perhaps once in a months.
Most centres would use Fentanyl 50-100 micrograms on an average for cough suppression before starng EBUS procedures.
Rapid on site Examinaon and slide evaluaon (ROSE) is restricted in very few centres where on site Cytopathologist is available so restricted to
few Teaching hospital set-ups. Only few centres would use Radial EBUS and very few centres would use Navigaonal Bronchoscopy for biopsy-
ing peripheral lung lesions
Both convenonal Bronchoscopy and EBUS TBNA biopsy is a part of curriculum training in most of the regions and trainees expected to have
200-300 Bronchoscopies in the ve years of Specialist Registrar training in UK with the aim of doing the procedure unsupervised in the nal
year of training if not already achieved. The numbers for EBUS is around 40 EBUS TBNA procedures to be done under supervision before reach-
ing competence levels to be able to do it independently. We do have simulated training and Bronchoscopy training on Mannequins in UK with
various training courses before starng Bronchoscopy or EBUS in real paents. Transbronchial Lung biopsies also part of training Bronchoscopy
in UK as well as Bronchial Biopsies with an expected hit rate of 80% on Endobronchial visible tumours and Brushings and Bronchoalveolar Lav-
age.
.
Education and Training
P A G E 10
20
th
WCBIP/WCBE – Co-organized with the Mayo Clinic, the Rochester world congress has just concluded this past June, and
we are happy to have welcomed the hundreds of aendees from over 40 countries, abstract presenters, faculty and keynote pre-
senters, sponsors and more. We would like to express our hearelt gratude to Dr. Eric Edell and sta for organizing a very suc-
cessful congress with the most in-depth scienc program for a WCBIP event to date.
(Le to right: Dr. Edell with his opening remarks; Nave Pride Dancers celebrang and blessing our gathering of guests at opening
ceremony; Prof. Udaya Prakash presenng)
WABIP Awards - These awards recognize our members who have made a signicant impact on the art and science of bronchol-
ogy, whether as a result of lifelong career achievements or subming an innovang and breakthrough abstract. Without further
ado, we are happy to announce the recipients of the 2018 WABIP Awards, who are:
The Gustav Killian Centenary Medal: Dr. Stefano Gasparini
WABIP-Dumon Award: Dr. Pablo Diaz-Jimenez
The Heinrich Becker Young Invesgator Awards for Research and Clinical Innovaon: Dr. Liyan Bo, Dr. Alex Chee, and Dr. Yu
Chen
(Le to right: –WABIP Chair Dr. Zsolt Papai and Awards commiee chair Dr. Pedro Grynblat presenng to Dr. Gasparini, Dr. Diaz-
Jimenez, Dr. Bo, Dr. Chee, Dr. Chen)
WABIP NEWS
P A G E 11
New Execuve Board - As the Rochester WCBIP congress has drawn to a close, a new term for leadership in the WABIP has
began. We are pleased to introduce the new roster of the Execuve Board, who are:
Chair: Silvia Quadrelli, M.D. (Argenna)
Vice-chair: Hideo Saka, M.D. (Japan)
Immediate Past-chair: Zsolt Papai, M.D. (Hungary)
Treasurer: David Fielding, M.D. (Australia)
21st WCBIP President: Guangfa Wang, M.D. (China)
22nd WCBIP President: Philippe Jean Astoul, M.D. (France)
(Le to right: Dr. Quadrelli, Dr. Saka, Dr. Papai, Dr. Fielding, Dr. Wang, Dr. Astoul)
Responsible for the “big picture” funconing and operaons of the associaon, the WABIP Execuve Board will connue to move
forward with our organizaon's mission and goals in advancing paent care, research, and educaon in bronchology, intervenon-
al pulmonology and related areas.
WABIP NEWS
P A G E 12
The Holy Grail of Pleurodesis
“Out Paent Pleurodesis”
The pursuit of outpaent pleurodesis has long been the focus of Intervenonal Pulmonologists.
As physicians taking care of paents with advanced malignancies and Malignant Pleural Eusions (MPE), we are well aware of the ominous
prognosis of a majority of these paents with few excepons such as breast cancer. In malignancies such as lung cancers, several studies (1)
show a dismal prognosis of less than a few months aer the discovery of MPE. In scenarios like these, the goal of therapy is more focused on
palliaon rather than cure and quality of life takes precedence over longevity with suering. Paents with such malignancies usually have al-
ready spent an inordinate amount of me in and around the hospitals for the diagnosc workup, extensive mul-modality treatments including
chemotherapy, surgery, and radiaon therapy. Quite oen they have also had recurrences, metastasis, and other complicaons adding to their
hospital visits and stays. MPE is and should be considered just another manifestaon of the above menoned, i.e., recurrence, metastasis, or
complicaon. The tradional approach of managing MPE has been repeated thoracentesis or a chest tube placement with or without chemical
pleurodesis in an inpaent seng. A large number of these paents are poor candidates for surgical intervenons such as mechanical pleu-
rodesis or decorcaons in case of complex MPEs. These approaches can take several days of hospital stay which takes away a big part of pa-
ent’s precious me from family and loved ones, not to menon the exponenally high cost of hospitalizaon compared to home and hospice.
As a consequence, Intervenonal Pulmonologists have been on the lookout for ways to manage MPE and other chronic, recurrent, and sympto-
mac pleural eusions in an outpaent seng. In the last approximately 15 years, the invenon of Indwelling Pleural Catheters (IPC) from Den-
ver, Colorado USA has proven to be a signicant step forward in that direcon. Now there are several iteraons of these catheters available
around the world. IPC can be placed in the procedure rooms or the clinics without adming paents to the hospital and can be drained by the
paents themselves, their family members or health care workers. Once there is no more uid drained for three consecuve drainages, which
usually happens in approximately 47% of the paents in approximately 54 days (2), these catheters can be removed in the outpaent oces or
clinics. However, as menoned earlier, about 50 % of the paents may connue to drain for several months and beyond or require an inpaent
chemical pleurodesis via the exisng catheters or more invasive procedures to achieve pleurodesis. Even in paents who do achieve pleurodesis
by merely draining the catheter at home on a daily basis or every other day basis, pleurodesis could take upwards of 50 days as menoned ear-
lier. Naturally, the next goal of physicians has been to achieve outpaent pleurodesis in more paents and much shorter period using IPCs.
There are several studies underway to achieve just that. These studies include drug-elung indwelling catheters, inslling sclerosing agents thru
the indwelling catheters or placing IPC following a relavely minimally invasive procedure called medical pleuroscopy and Talc poudarage.
Editorial Staff
Associate editor: Dr. Ali Musani
Associate editor: Dr. Sepmiu Murgu
Editor-in-Chief: Dr. Kazuhiro Yasufuku
Research
Primary Business Address:
Kazuhiro Yasufuku, Editor-in-Chief
WABIP Newsleer
c/o Judy McConnell
101 College St., TMDT 2-405
Toronto, Ontario M5G 1L7
Phone: 416-581-7486
E-mail: newsleer@wabip.com
P A G E 13
Research
P A G E 14
One such study is the focus of our discussion today. This study was recently published in the New England Journal of Medicine (3). In this study,
154 paents from 18 centers in the UK were randomized into two groups. One group received 4 grams of Talc thru the IPC as outpaents while
the other group received placebo. The paents were followed to look for the rate of pleurodesis, me to pleurodesis and clogging of the cathe-
ters among other outcomes. The study shows that the rate of pleurodesis in the talc group was 43% compared with the pleural catheter alone
or placebo group was 23 % at 35 days. No signicant excess of blockages of the indwelling pleural catheter was noted in the talc group. No sig-
nicant dierences in adverse events were idened either.
Although this study shows a signicantly high rate of pleurodesis in the talc group vs. the placebo group, it is not much higher than some of the
US and Canadian studies showing pleurodesis rates of around 40 % by just IPC. However, in those studies, the me to pleurodesis was signi-
cantly higher, i.e., upwards of 50 days.
The Study from Dr. Maskell's group is the rst of its kind opening the door for the outpaent chemical pleurodesis. More studies of dierent
agents delivered in various fashions such as drug-elung IPCs and installaon of various chemicals via IPCs will eventually bring us closer to our
target of achieving minimally invasive, rapid, and outpaent pleurodesis with the goal of enabling paents to spend more me in the comfort of
their homes surrounded by their families and friends.
References:
1. Jeba et al. Indian J Palliat Care. 2018 Apr-Jun; 24(2): 184–8.
2. Wahidi et al..Am J Respir Crit Care Med. 2017 Apr 15;195(8)
3. Bhatnagar et al. N Engl J Med. 2018 Apr 5;378(14):1313-22.
P A G E 15
Internaonal Conference on Intervenonal Pulmonology and Hands-on Training Program - IP2018
Organized by – Bangladesh Associaon for Bronchology and Intervenonal Pulmonology (BABIP)
Endorsed by - World Associaon for Bronchology and Intervenonal Pulmonology (WABIP)
Summary
The 1
st
internaonal conference on Intervenonal Pulmonology organized by BABIP is a landmark in the history of Intervenonal Pulmonology
of Bangladesh. Since its birth on 2015, BABIP had arranged scienc conferences each year. But this is the rst me when BABIP could arrange
a successful and truly internaonal program. Geng the endorsement of WABIP heightened the aristocracy of the event. It was our great priv-
ilege to get a mentor Henri Colt, MD, FCCP, FAWM, Emeritus Professor, Respiratory and Crical Care Medicine, University of California, USA
who guided, gave valuable advices and unfeered
supports and lastly wrote an enchanng message for
souvenir that enlightened the parcipants.
The conference was held on May 13
th
-14
th
, 2018 in
Bangabandhu Internaonal Conference Center
(BICC) and Square Hospitals Ltd., Dhaka. On 13
th
May
the conference started at 8.20 am. Professor Mirza
Mohammad Hiron, Chairman and Dr. Md. Sayedul
Islam, Secretary General of BABIP inaugurated the
scienc session. Total 289 delegates from home
and abroad parcipated in the conference. Among
them there was specialist and trainee pulmonologists,
internists, thoracic surgeons, pediatric pul-
monologists, intensivists and respiratory nurses.
Total 8 facules from Japan, UK, Thailand and India along with local facules took part in the scienc program. Especially the presence of
Professor Hideo Saka, Secretary General of WABIP increased the elegance of the program. Other facules were Dr. Jamsak Tscheikuna, Associ-
ate Professor, Respiratory Medicine, Mahidol University, Thailand; Dr. Kedar Hibare, Intervenonal Pulmonologist, Narayana Health, India and
Chair, WABIP Social Media Commiee; Dr. Sushmita Roychoudhury, Intervenonal Pulmonologist, Apollo Glenegels Hospital, Kolkata; Dr. Bala
Raju Tadikonda, India; Dr. Gella Vishwanath, India; Dr. Kanumuri Sreenivasa Rao, India; Dr. Gopala Krishna Mallugari, India; Dr. Md. Sayedul
Islam, Associate Professor, Respiratory Medicine, Naonal Instute of Diseases of the Chest and Hospital (NIDCH), Bangladesh and WABIP
Regent for Bangladesh; Dr. Nirmal Kan Sarkar, Consultant, Respiratory Medicine, NIDCH, Bangladesh; Dr. Fazle Rabbi Mohammed, Associate
Consultant, Respiratory Medicine, Square Hospital, Bangladesh; Dr. Raihan Rabbani, Consultant, ICU, Square Hospital, Bangladesh; Dr. Md.
Khairul Anam, Associate Professor, Respiratory Medicine, Shaheed Suhrawardy Medical College, Bangladesh and Dr. Md. Aminul Islam, Associ-
ate Professor, Respiratory Medicine, Dhaka medical college, Bangladesh. The aim of the conference was to disseminate and exchange of
knowledge on basics and advances of Intervenonal Pulmonology among the parcipants as well as conduct an eecve hands-on workshop.
Parcipants at a glance
Professor Mirza Mohammad Hiron Dr. Md. Aminul Islam
P A G E 16
Day-1, Session-1
The scienc session started with a lecture of Dr. Nirmal Kan Sarkar on “Fiberopc Bronchoscopy- How I do it”. His discussion included de-
tails of step-by-step procedure, paent preparaon, segmental anatomy, complicaons during bronchoscopy and a video presentaon. Dr.
Fazle Rabbi Mohammed spoke on “Bronchoscopic sample collecon” which covered BAL, brush, biopsy technique and transbronchial lung
biopsy. Dr. Md. Khairul Anam focused on dierent aspects and scopes of bronchoscpy in ICU. Dr. Gella Vishwanath nicely illuminated on
“Bronchoscopic management of haemoptysis”.
Day-1, Session-2
This session started by the lecture of Dr. Md. Sayedul Islam on “Intervenonal Pulmonology: past, present and future” – a very colorful lecture
where he depicted the history of intervenonal pulmonology, scopes of IP in respiratory medicine, and recent advancement in this eld. The
state-of-the-art lecture by Professor Hideo Saka was on “Bronchoscopic diagnosis of peripheral pulmonary nodule” for which audiences were
eagerly waing. He discussed the details of diagnosc approaches, dierent modalies, thin and ultrathin bronchoscope in a very easy way.
The audience warmly applauded his discussion.
Day-1, Session-3
Dr. Md. Aminul Islam told on “8
th
TNM classicaon of lung cancer” with changes from previous 7
th
staging. Dr. Gopala Krishna Mallugari
spoke on “cTBNA - How I do it and it’s relevance in the era of EBUS” a very important topic especially for our country where EBUS not readily
available and costly one. Dr. Sushmita Roychoudhury gave a beauful lecture on “EBUS – Basics”. She discussed in an easy way the details of
EBUS procedure. Next topic was by Dr. Kedar Hibare on “EBUS – Stretching boundaries” a dynamic lecture where he stretched boundaries and
just mesmerized the audience by his very nice discussion on details of EBUS.
Faculty and Organizers
Pictured le to right: Dr. Nirmal Kan Sarkar, Dr. Fazle Rabbi Mohammed, Dr. Md. Khairul Anam and Dr. Gella Vishwanath
Professor Hideo Saka Dr. Md. Sayedul Islam
Pictured le to right: Dr. Md. Aminul Islam, Dr. Gopala Krishna Mallugari, Dr. Sushmita Roychoudhury and Dr. Kedar Hibare
Day-1, Session-4
Dr. Jamsak Tscheikuna gave a wonderful lecture on “Rigid Bronchoscopy – How I do it” which covered approaches, scopes, advantages and im-
portance to learn rigid bronchoscopy for an intervenonal pulmonologist along with berscope. Dr. Kanumuri Sreenivasa Rao told on “Medical
Thoracoscopy” and discussed details of procedure and shared his vast experience with audience showing several cases. Dr. Raihan Rabbani dis-
cussed on “Perecutaneous Tracheostomy” sharing his ICU experience, how and when to do. Dr. Bala Raju Tadikonda closed the rst day session
by sharing his long and challenging experiences on “Bronchoscopic foreign body removal in pediatric paents” – a mind blowing discussion in-
deed.
Day-2, Session-1
This session started with another vibrant lecture by Professor Hideo Saka on “Cryoprocedures in Intervenonal Pulmonology”. His discussion cov-
ered in-depth of cryoprocedure in dierent lung lesion. Dr. Gella discussed on applicaon of heat in dierent lung pathologies in his lecture “Fire
in Intervenonal Pulmonology – APC, electrocautery and laser”. Dr. Fazle Rabbi Mohammed briey discussed on “Baloon bronchoplasty”.
Day-2, Session-2
Dr. Gopal Krishna Mallugari started this session with basics of “Airway stenng” and shared his experience. Dr. Kedar gave another brilliant lec-
ture on “Next generaon of airway stents” which included convenonal as well as 3D and biodegradable stent and future aspects in this eld. Dr.
Bala Raju highlighted on applicaon of “Bronchial Thermoplasty” in asthma management. The lecture session was concluded by Dr. Sushmita Roy-
choudhury focusing on – “Year in review – Intervenonal Pulmonology”.
Hands-on Training program
On 2
nd
day of program, a very well formaed hands-on training program was arranged at Square Hospitals Ltd. Total 62 registered parcipants
took part in the program. There were 9 staons namely Basic bronchoscopy including bronchial anatomy and sample collecon, cTBNA, Baloon
bronchoplasty, Convex probe EBUS, Radial probe EBUS, Cryo and APC, Rigid bronchoscopy and airway stenng, Percutaneous tracheostomy and
Indwelling pleural catheter. Parcipants were divided into 9 groups with 7 persons in each group. Procedures were done on mannequin and ani-
mal cadaver. The instructors were full of energy to teach and the learners were acve in learning and got ample me to do all the procedures in
each staon by themselves.
Pictured from le to right: Dr. Jamsak Tscheikuna, Dr. Kanumuri Sreenivasa Rao, Dr. Raihan Rabbani and Dr. Bala Raju Tadikonda
Professor Hideo Saka
Panelists on stage
From le to right: Basic bronchoscopy staon, parcipants at workshop, cryo staon, EBUS-TBNA staon
Cercates were distributed among the parcipants. The program was concluded by the Chairperson and Secretary General, BABIP thanking all
to make the program a successful one.
From le to right: Praccing on animal cadaver, IPC staon, cTBNA staon, EBUS-TBNA staon
From le to right: Workshop at a glance, radial probe EBUS staon, balloon bronchoscopy staon, rigid bronchoscopy staon
Cercate distribuon Photo session with workshop parcipants and faculty
P A G E
19
WABIP ACADEMY- WEBCASTS
The WABIP has started a new educaon project recently: THE WABIP ACADEMY. The WABIP Academy will pro-
vide free online webcasts with new and hot topics that will interest pulmonologists and intervenonalists.
Current webcast topic: Tissue acquision for biomarker directed therapy of NSCLC
You can reach these webcasts by using this link: hp://www.wabipacademy.com/webcast/
www.bronchology.com Home of the Journal of Bronchology
www.bronchoscopy.org Internaonal educaonal website for
bronchoscopy training with u-tube and
facebook interfaces, numerous teachiing
videos, and step by step tesng and assess
ment tools
www.aabronchology.org American Associaon for Bronchology and I
ntervenonal Pulmonology (AABIP)
www.eabip.org European Associaon for Bronchology and
Intervenonal Pulmonology
W A B I P N E W S L E T T E R
Links
www.chestnet.org Intervenonal Chest/Diagnosc Procedures (IC/DP)
NetWork
www.thoracic.org American Thoracic Society
www.ctsnet.org The leading online resource of educaonal and
scienc research informaon for cardiothoracic
surgeons.
www.jrs.or.jp The Japanese Respirology Society
sites.google.com/site/asendoscopiarespiratoria/
Asociación Sudamericana de Endoscopía Respiratoria
P A G E 19
P A G E
20
UPCOMING EVENTS
Pulmo Delta 7th Annnual Delta Conference of ESCT
When: October 4-6, 2018
Where: Alexandria -Egypt
Program Director: Prof. Dr. Ramadan Nafea
Program Type: Conference (didacc lectures)
Website: hps://www.wabip.com/events/371-pulmo-delta-2018
4th Annual Scienc Meeng of the Malaysian Associaon for Bronchology and Intervenonal Pulmonology
When: October 12-14, 2018
Where: MALAYSIA
Program Director: DR RAZUL MD NAZRI MD KASSIM
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hp://www.mabip.com
Fih Annual Percutaneous Tracheostomy and Advanced Airway Cadaver Course
When: October 22, 2018
Where: MISTC Lab, The Johns Hopkins Hospital, Balmore, MD
Program Director: Hans Lee, MD
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hps://hopkinscme.cloud-cme.com/aph.aspx?P=5&EID=13574
Advanced Bronchoscopy Course (Egypt)
When: October 25-26, 2018
Where: Steigenberger Hotel El Tahrir Cairo
Program Director: Prof. Emad Korraa
Program Type: Hands-on workshop
Website: hps://www.wabip.com/events/384-advanced-bronchoscopy-course-organized-egypt
W A B I P N E W S L E T T E R
P A G E 20
P A G E
21
UPCOMING EVENTS
Amrita Bronchology & Intervenonal Pulmonology 2018
When: October 27-28, 2018
Where: Where: Amrita Instute Of Medical Sciences, Kochi, India
Program Director: Dr. Arvind Perathur & Dr. Tinku Joseph
Program Type: Educaonal seminar (postgraduate may include physicians in pracce and trainees), Hands-on workshop, Confer-
ence (didacc lectures)
Website: hp://www.abip.co.in/
IX Congreso Paraguayo de Neumologia
When: October 31 - November 3, 2018
Where: Asuncion, Paraguay
Program Director: Domingo Perez Bejarano, M.D.
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hp://www.congresoneumo.com.py/
Ninth Annual Evaluaon and Management of Pleural Disease
When: January 21-22, 2019
Where: The Johns Hopkins Hospital, Balmore, MD
Program Director: David Feller-Kopman, MD, FCCP
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hps://hopkinscme.cloud-cme.com/aph.aspx?P=5&EID=14934
8th Asian Pacic Congress on Bronchology and Intervenonal Pulmonology
When: March 27-30, 2019
Where: Gold Coast Convenon and Exhibion Centre, Broadbeach QLD 4218, Australia
Program Director: David Fielding, M.D.
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hp://www.apcb2019.com
W A B I P N E W S L E T T E R
P A G E 21
