Volume 11
Issue 01
January 2023
Inside This Issue
Editorial, 2-3
Technology Corner, 4-6
Tips from the Experts, 7-9
Humanitarian News, 10-13
Best Image Contest, 14
WABIP News, 15-16
Educaon, 17-22
Research, 23-24
Links, 25
Philippe ASTOUL, MD, PhD
WCBIP 2022 President
Hervé Dutau, MD
WBCE 2022 President
A Look Back at WCBIP/WCBE 2022 Marseille
WABIP Newsletter
J A N U A R Y 2 0 2 3 V O L U M E 1 1 , I S S U E 1
EXECUTIVE BOARD
Stefano Gasparini, MD
Italy, Chair
Pyng Lee, MD, PhD
Singapore, Vice-Chair
Hideo Saka, MD
Japan , Immediate Past-
Chair
David Fielding MD
Australia, Treasurer
Naofumi Shinagawa, MD
Japan,
Secretary General
Menaldi Rasmin, MD, PhD
Indonesia , President
WCBIP 2024
Rajesh Thomas, MD, PhD
Melbourne , President
WCBIP 2026
STAFF
Michael Mendoza
General Manager
Judy McConnell
Administrator
Kazuhiro Yasufuku
Newsleer Editor-in-chief
P A G E 2
Looking back at the program, events and parc-
ipants of WCBIP/WCBE 2022 in Marseille held
from October 6-9, we are very delighted and
proud to say that the congress was an out-
standing success. The magnicent Palais du
Pharo (built under Napoleon III – XIXth century)
overlooking our 'Vieux Port' ('old Harbour') in
Marseille down town and its modern integrated
congress center was the seng for these two
and a half days of rich encounters and unfor-
geable exchanges.
Despite a dicult period marked by the COVID-
19 pandemic, a war next door, the economic
dicules of our daily lives and consequently
an uncertain future, less than 1% of the 766
acve parcipants (from 81 countries) used the
remote system (mainly by speakers). This
means two things: rst, a long desire to meet
up with colleagues aer a prolonged frustraon
of on-site meengs and second, the fact that
the intervenonal pulmonology community is a
true family with in mind the necessity of conn-
uous friendly collaboraons, ideally physical, for
sharing knowledge, for construcve cricisms,
i.e., a connuous medical educaon in this per-
petual fast-moving eld. The congress oered
high-caliber scienc sessions with emphasis on
new bronchoscopy and pleural techniques,
technologies and hands-on procedure work-
shops and it is hard to pick special moments
among the 44 sessions (including 10 plenary
sessions), 6 industry symposia and 6 workshops
allowing colleagues to have the opportunity to meet
experts in dedicated elds.
Parcipants could note a balance, a new fact, be-
tween bronchology and what we will call
‘pleurology’ (pleural techniques including medical tho-
racoscopy), the laer, undoubtedly too long in the
background, but which is an integral part of the inter-
venonal pulmonology and which broadens the im-
portance of pulmonologists in this eld. The sessions
in which our surgeon colleagues took part emphasized
this fact. In the same vein, the sessions dedicated to
the learning of the dierent techniques were parcu-
larly followed and the evoluon of a learning of the
techniques by companionship toward a teaching ‘step
by step’ with rigorous evaluaon according to precise
criteria dened by groups of work for each stage of
acquision must become the standard in the near fu-
ture. For sure, collaboraons between the dierent
internaonal associaons are crucial to design a
unique educaonal program for young (but also more
skill) doctors involved in the intervenonal pulmonol-
ogy. The 'teachers' need also to be taught to design
and organize appropriate educaonal courses
throughout the world. In another word 'to teach the
teachers'.
The opening ceremony on Thursday night (Oct. 6) was
an early indicator of posivity and success. Aer the
president WCBIP 2022 welcome speech (your humble
servant), that of the president of the WCBE (my col-
laborator and friend Hervé Dutau), of the presidents
of the WABIP (Hideo Saka) and IBES (Jan Kasperbau-
W A B I P N E W S L E T T E R
P A G E 3
During these two and half days of sharing many topics
and discussions were related to early diagnosis, preci-
sion staging, and intervenonal therapies in the eld
of thoracic cancers but also of chronic inammaon of
the airways (asthma, COPD) which will represent in the
future through the ELVR, the cryoablaon and other, a
complementary armamenterium for the management
of these diseases. The congress also covered other
technologies or elds in bronchology and pleurology
such as benign or malignant airway stenosis, cryobiop-
sy, thoracoscopy and other pleural procedures, trans
thoracic modalies and IP educaon. Briey to say that
WCBIP 2022 showed a full spectrum of intervenonal
pulmonology and we are very proud in Marseille to
have been the seng for this beauful specialty
through the WABIP, which we thank very warmly as
well as all colleagues for their trust, hoping to have
lived up to
it.
As presidents of the WCBIP/WBCE 2022, Philippe
Astoul and Hervé Dutau wish to our Indonesian Col-
leagues a great success for the next WCBIP 2024
which will be held in Bali (October 23rd – 25th, 2024).
Long live WABIP !
With our warmest regards,
Philippe ASTOUL, MD, PhD
WCBIP 2022 President
Hervé Dutau, MD
WBCE 2022 President
er), several colleagues were awarded tesfy-
ing to their commitment in the eld of inter-
venonal pulmonology but also to the vitality
of all parcipants of the WABIP recognizing
signicant contribuons to bronchology and
intervenonal pulmonology. This is how the
various prizes were awarded to Marn Philips,
Australia, (Gustav Killian Centenary Medal) for
career achievements and clinical pracces
which made a signicant impact on the art and
science of bronchology, Sepmiu Murgu, USA,
(WABIP Dumon Award) for contribuons to
enhancing others’ skills in rigid bronchoscopy
and improving knowledge and understanding
of central airway obstrucon, Spasoje Popevic,
Serbia, (Disnguish WABIP Regent Award), for
signicant contribuons to the development
of WABIP acvies in Serbia and worldwide
during his term as Regent, and nally Teruomi
Miyazawa, Japan, (WABIP Lifeme Achieve-
ment Award), for outstanding achievements
and contribuons to the clinical pracce of
bronchology and intervenonal pulmonology
and who granted to the on-site audience a
very emoonal video message thanking all the
intervenonal pulmonology community for his
carrier. Young doctors were not forgoen with
the Heinrich Becker Young Invesgator
Awards for Research and Clinical Innovaon
given to Keisuke Kirita (Japan), Sandip Saha
(USA), Øyvind Ervik (Norway). A special men-
on to the team from Sarawak General Hospi-
tal (Malaysia) which won the WABIP Video
Fesval (best imaging, best innovaon, best
scienc) with a video entled ‘Virtual Bron-
choscopy Navigaon (VBN) Guided Recanaliza-
on of Post Tuberculosis Right Main Bronchus
Chronic Total Occlusion’ (Author: Kho Sze-
Shyang – Watch video at
hps://youtu.be/95Fjk_weTIU)
W A B I P N E W S L E T T E R
P A G E 4
Technology Corner
Ulizaon of Illumisite
for Electromagnec Navigaon Bronchoscopy with
Digital Tomosynthesis and Connuous Tip Tracking
Introducon:
Electromagnec navigaon bronchoscopy (ENB) is a minimally invasive technology that guides bronchoscopes and biopsy tools to
pulmonary lesions. This technology has improved the ability to access peripheral lung lesions, but its historical diagnosc yield has
been subopmal. This limitaon was related to several factors, including the lack of integrated real-me imaging to account for CT-
to-body divergence and the lack of visualizaon of catheter posion during the biopsy phase of the procedure. The latest evoluon
of ENB combines digital uoroscopic tomosynthesis with connuous p tracking in the Illumisite
system (Medtronic, Plymouth,
Minnesota, USA) to overcome these barriers. Inial studies using this modality have been promising.
Background:
ENB uses a CT scan performed prior to the procedure to generate a virtual tracheobronchial tree so the proceduralist can create a
virtual pathway to the target lesion. CT-to-body divergence occurs when the virtual posion of the marked target on the CT scan,
which is performed at total lung capacity in an awake, spontaneously breathing person, and the actual posion of the lesion in the
paent under anesthesia dier, leading to a signicant challenge in obtaining a diagnosc specimen. Anesthesia protocols have been
developed to migate this phenomenon, but they cannot completely compensate for the CT-to-body divergence.
Digital uoroscopic tomosynthesis allows for correcon of CT-to-body divergence during the procedure. Aer automac registraon
is performed, navigaon to the target nodule occurs in standard fashion. Catheter manipulaon is performed manually allowing for
maximal precision, and speed is dependent upon the operator; it is not limited by a mechanical drive system as with other plaorms.
Once the catheter is within 2 cm of the target lesion, local registraon can be performed. This process ulizes a standard 12-inch 2-
dimensional C-arm uoroscope sweeping 50-degrees obliquely around the target lesion. With this newly acquired real-me data,
digital tomosynthesis is ulized to obtain a 3-dimensional reconstrucon of the area surrounding the target. The real-me locaon
of the lesion and catheter is idened, marked, and updated to allow for adjustments prior to radial ultrasound evaluaon and/or
biopsy (Figure 1).
An addional feature of the Illumisite
system is connuous real-me p tracking of the catheter. Prior ENB plaorms lose visuali-
Bryan S. Benn, MD, PhD
Pulmonary Department,
Respiratory Instute,
Cleveland Clinic, Cleveland, Ohio
Jonathan S. Kurman, MD, MBA
Division of Pulmonary and
Crical Care,
Medical College of Wisconsin,
Milwaukee, Wisconsin
W A B I P N E W S L E T T E R
P A G E 5
zaon of the target lesion and biopsy tool interacon when the locatable guide (LG) is removed from the extended working channel
(EWC). With the Illumisite
system, the cardinal direcons of movement are integrated into the EWC to allow for the ability to visu-
alize the interacon of the biopsy tool with the target lesion (Figure 2).
Clinical Applicaon:
How we do it
We perform our procedures under general anesthesia with neuromuscular blockade, fracon of inspired air (FiO
2
) between 40-60%,
dal volume of 6-8ml/kg ideal body weight and posive end expiratory pressure (PEEP) of at least 10cm H
2
O through an 8.5mm en-
dotracheal tube. PEEP of 15cm H
2
O is used for paents with severe obesity. Paents are also preoxygenated with 80% FiO
2
in order
to limit resorpon atelectasis. Aer navigang to within 2 cm of the target lesion, the bronchoscope is aached to a stabilizaon sys-
tem (Mediex, Islandia, NY, USA).
Once local registraon is launched, the adjustable pressure liming (APL) valve on the venlator is set to 15-20cm H
2
O (5cm greater
than the PEEP level) and the alveolar pressure is allowed to reach the same plateau value as seen by the venlator waveform. Manu-
al compression of the anesthesia machine bag is avoided. A 50-degree uoroscopic sweep is then performed during this breath hold
maneuver, with the acquired data then processed by the Illumisite
system. The sweep occurs over approximately 15 seconds.
Supporng Literature
Inial studies comparing the addion of digital tomosynthesis alone to tradional ENB (1) and the use of the Illumisite
system (2-4)
have shown promising results with minimal complicaon rates comparable to prior ENB studies. Introducon of uoroscopic digital
tomosynthesis to ENB improved diagnosc yield to 79% in 67 nodules compared to 54% in 101 nodules biopsied with ENB alone (1).
Diagnosc yield with the Illumisite
system ranges from 83-87% (2-4). Average reported corrected CT-to-body divergence was 12.2-
15.4mm when ulizing the Illumisite
system (1,3).
When assessing tradionally more challenging nodules that are smaller in size, dened as <2cm in diameter in all direcons, and radi-
ographic bronchus sign negave, results were also encouraging. In a prospecve, single center study, 75% (n=54/72) of lesions that
were <2cm in all dimensions were diagnosc, as were 79% (n=83/105) of bronchus sign negave lesions (4). A recent study compar-
ing the Illumisite
system with roboc bronchoscopy found comparable diagnosc yields of 80% and 77%, respecvely (5). The safe-
ty proles were also similar.
Conclusions:
Eorts to improve results of diagnosc bronchoscopy for peripheral lung lesions have led to signicant gains in the safety and accura-
cy of these procedures. Ulizing ENB with uoroscopic digital tomosynthesis to idenfy the locaon of the target lesion locaon in
real-me with connuous catheter p tracking through the Illumisite
system facilitates real-me biopsy tool-lesion interacon
feedback and overcomes CT-to-body divergence. Inial studies show improved diagnosc yields, including for smaller lung nodules
and those without a radiographic bronchus sign. Future studies evaluang the Illumisite
system in comparison to other diagnosc
bronchoscopy technologies and to TTNA will help inform which paents and which nodule characteriscs may benet from a specic
biopsy approach.
W A B I P N E W S L E T T E R
P A G E 6
References:
1. Aboudara M et al. Respirology. 2020;25(2):206-213
2. Avasarala SK et al. Respiraon. 2022;101(2):166-173
3. Dunn BK et al. J Bronchology Interv Pulmonol. [published online ahead of print, 2022 Mar 10]
4. Gmehlin CG et al. Respir Med. 2022;202:106941
5. Low SW et al. Chest. 2022;22:04032-6
Figure 1. A) Posion of the locatable guide (LG) aer navigang to the virtual target but before local registraon, which in-
volves real-me imaging using digital tomosynthesis. B) Posion of the LG aer local registraon. CT-to-body divergence re-
sulted in 1.4cm of discrepancy between the nodule’s preoperave and intraoperave locaon in this case. Catheter posion
can then be adjusted to account for this dierence. (Images courtesy of Medtronic.)
Figure 2. A) Preoperave CT chest demonstrang a sub-
cenmeter semisolid pleural-based nodule (white arrow)
directly behind a rib. B) The same nodule (white arrow)
is made uoroscopically visible by digital tomosynthesis
during the local registraon process, allowing the bron-
choscopist to account for CT-to-body divergence and
target the nodule’s real-me posion. C) Connuous p
tracking allows for visualizaon of the extended working
channel’s (EWC) exact posion even aer removing the
locatable guide (LG). D) Targeng mode allows for pre-
cise biopsy from dierent regions of the target lesion,
which can migate the impact of tumor heterogeneity.
The operator can also mark each biopsy posion virtual-
ly. (Images courtesy of Medtronic.)
Tips from the Experts
P A G E 7 V O L U M E 1 1 , I S S U E 1
Introducon:
The widespread availability and use of computed tomography (CT) have led to increased nodule detecon rate that prompted a need for
improved technology to aid in diagnosc procedures. In the modern era of diagnosc bronchoscopy, there has been an advent of innovave
plaorms, including electromagnec navigaon bronchoscopy (ENB) and roboc-assisted bronchoscopy (RAB). However, bronchoscopists
connue to have substanal challenges and have not achieved the diagnosc yield seen with a transthoracic approach [1]. One of the main
reasons for this shortcoming is the presence of CT-Body Divergence (CTBD). Combining arcial intelligence (AI) guided real-me imaging
such as C-arm Based tomosynthesis (CABT) with navigaon plaorms can potenally help improve diagnosc yield and accuracy.
Indicaons:
ENB and RAB have proprietary soware that uses a pre-procedure CT scan of the chest with a thin-slice protocol (1mm thickness) that is
obtained at full inspiraon (Total lung capacity - TLC) to build a virtual-navigaon pathway for intra-procedural guidance. CTBD results from
a physiological dierence in lung volume that shis airway anatomy and locaon of the lesion that may aect the intra-procedural accuracy.
During the procedure, paents are under posive pressure and not at TLC, whereas during the CT they were at TLC, with a breath hold, and
not under posive pressure. Furthermore, anatomical posional dierences with respect to the posioning of the arms (upright), chest wall,
which is expanded and lateralized at the me of imaging are dierent from the me of the procedure; the development of intra-procedural
atelectasis secondary to lower lung volumes, higher FiO2 during anesthesia, procedural me and bronchoscopic tool manipulaon of the
airway, may also contribute to the deviaon of the actual real-me pathway from the prior virtual pathway created. This variaon has been
studied with a pre-procedure CT performed at full inspiraon and expiraon in 46 paents (85 lesions) that detected an average moon of
17 mm in all lesions [2]. Similarly, another study that looked at planning CT and intra-procedure CBCT reported an average divergence of 14
mm [3]. This has been documented and noted across several peripheral navigaon plaorms (ENB and RAB) [4].
The role of real-me imaging (CABT) to conrm lesion locaon serves an essenal role in diagnosc procedures. For parenchymal lesions,
depending on the locaon of the lesion, CTBD can signicantly aect the relaonship in the posioning of the tool and lesion. CTBD is noted
to be highest in the lower lobes and although there are strategies that can be used to minimize CTBD and atelectasis (eg. adjusng venla-
tor sengs), knowing a real-me relaonship between tool and the target lesion adds signicant value intra-procedurally and may increase
the diagnosc yield when used in conjuncon with navigaon plaorms [3,4].
Planning:
For our procedures, we use the Monarch® system as the navigaon plaorm (Auris Health, CA) and Lung Vision (Body Vision Medical Ltd,
Israel) device for augmented uoroscopic imaging, which connects to our standard OEC Elite c-arm (GE).
Body Vision's proprietary technology, Lung Vision, ulizes CABT which allows for updated conrmaon of a lung nodule in real me based
on tomosynthesis registraon of the lesion. The system uses any standard C-arm to reconstruct a 3-dimensional intraprocedural image of
the target, thus overcoming CTBD. Addionally, the Body Vision plaorm provides uoroscopic visualizaon of pre-planned pathways and
visualizaon of tool to lesion relaonship, both of which can help ne-tune the bronchoscope's posion regardless of the navigaon
plaorm used. A pre-procedure CT scan is uploaded to the tablet, and the lesion pathway is marked. A CT scan is also uploaded to the Mon-
arch planning soware which performs the airway segmentaon and a virtual pathway is created to the lesion.
There are several ways to minimize CTBD. In our pracce, we employ a venlaon protocol of PEEP of 10, a dal volume of 6-8 ml /Kg pre-
C-Arm Based Tomosynthesis for real-me Augmented Fluoroscopy imaging during
Roboc Bronchoscopy
D. Kyle Hogarth, MD
Professor of Medicine
Co-Director, Lung Cancer Screening Program
Director, Bronchoscopy
Medical Director, Pulmonary Rehabilitaon
Program
University of Chicago
Nakul Ravikumar, MD
Fellow, Intervenonal Pulmonology
University of Chicago
Tips from the Experts
P A G E 8 V O L U M E 1 1 , I S S U E 1
dicted body weight, and a FiO2 of 0.4 or less as allowed by oxygen saturaon and hemodynamic stability. Once under general anesthesia, a 2-
step registraon is performed to integrate the pre-operave CT scan with the C-arm spin tomosynthesis. The rst step is registraon of the
main carina which is performed with a C-arm spin typically from -35 degrees to +35 degrees (LAO to RAO) aer which the C-arm is iso-
centered on the lesion and registraon of the lesion is performed with breath-hold with APL of 20cm. This process takes about 2-3 minutes.
Aer registering the lesion, the C-arm is pulled back, and an inspecon bronchoscopy is performed for airway surveillance to rule out central
airway lesions and to clear secreons. Aer the survey, the roboc bronchoscope is introduced to navigate to the lesion. The bronchoscope is
advanced ll about 2cm from the lesion (Figure 1A). The C-arm is then iso-centered back on the lesion and nal navigaon and posioning is
performed before sampling.
Sampling:
Aer the nal navigaon is performed to the updated target locaon, a radial EBUS is advanced to idenfy and conrm the lesion locaon,
proximity to the scope and to understand beer the relaonship with respect to the working channel to the best of the ability (Figure 1B). If
no radial EBUS imaging is obtained (Figure 1C), as is the case in a semisolid and ground glass nodule, sampling is performed based on the tar-
get locaon obtained by tomosynthesis (Figure 1D). A biopsy tool, either needle or forceps, is used for sampling. Once the bronchoscope and
tool are advanced to the lesion, another spin can be performed before the biopsy to visualize the tool-lesion relaonship to obtain real-me
feedback and conrm "tool in lesion". All biopsy specimens are then reviewed with the onsite pathologist to ensure adequate qualitave and
quantave sampling (Figure 1E). We terminate the procedure by slowly withdrawing the bronchoscope while ensuring that there is no
bleeding with 5-10 ml saline irrigaon.
Of note, we rounely use radial EBUS for our bronchoscopic procedures targeng lung nodules. Published data show increased yield in le-
sions that give a concentric view (84%) vs. eccentric view (48%) [5]. However, radial EBUS can give pseudo-assurance of posioning as it can
be aected by atelectasis or tool-related manipulaons that lead to microhemorrhages. At our instuon, we performed a retrospecve
study of 45 paents who had a diagnosc bronchoscopy that combined these technologies with an average lesion size of 16 mm. A radial
EBUS conrmaon was obtained in 73% of cases, and an immediate diagnosis was obtained in 38 of 45 cases (84%); 32 cases were malignant
and six were consistent with specic benign eology. The other 7 lesions demonstrated inammaon (n=4) or were non-diagnosc/atypical
(n=3). Of these 7, two had stable ndings at 1-year follow-up and one had a surgical wedge biopsy that was benign, leading to an overall diag-
nosc accuracy in 41/45 (91%) [6].
Quality control:
Real-me imaging is possible via radial EBUS and/or uoroscopy (Cone-beam CT and CABT) to provide addional insight at the me of the
procedure. While CABT represents a useful tool, the resoluon needs to improve further. With the added use of CABT, increased radiaon
exposure, uoroscopy me and procedure me is possible and studies evaluang these factors in CABT with RAB need to be performed. Cur-
rently, the radiaon dose from a Lung Vision procedure is 1/3
rd
that of Cone Beam CT. The diagnosc accuracy even with use of real me im-
aging is not a 100% and there is limitaon to the “tool in lesion” concept and a bronchoscopist must use appropriate clinical judgement in
decision making in non-diagnosc cases.
Conclusion:
Given the current ability of newer plaorms to navigate further into the lung parenchyma, the use of augmented uoroscopy to obtain intra-
procedural imaging helps beer dene the tool-lesion relaonship and assist the bronchoscopist in maneuvering while increasing the yield
and accuracy in diagnosis of peripheral lung nodules, thus liming the need for addional procedures.
References:
1. Han et al. PLoS One. 2018 Jan; 22;13(1)
2. Chen et al. Chest. 2015 May; 147(5)
3. Pritche M. Journal of Thoracic oOncology. 2018 Oct; S403
4. Reisenauer J et al. Mayo Clin Proc Innov Qual Outcomes. 2022 Apr 23;6(3):177-185
5. Chen A et al. Ann Am Thorac Soc. 2014 May; 11(4):578-82
6. Hedstrom G et al. Chest. 2022 Vol 162 (4), A2082
Tips from the Experts
P A G E 9 V O L U M E 1 1 , I S S U E 1
Figure 1: A: Roboc bronchoscopy Navigaon, B: Radial EBUS advanced to the locaon of the nodule as determined on the CABT images
post registraon (Yellow spot marks the nodule), C: Radial EBUS advanced to the lesion but no ultrasonographic imaging of the nodule
obtained, D: Biopsy of the nodule with forceps, E: Rapid onsite evaluaon of the nodule biopsy showing non-small cell lung cancer with
nal path revealing poorly dierenated squamous cell lung cancer.
Humanitarian News
W A B I P N E W S L E T T E R P A G E 10
The Ethics of Migraon in the Times of Pandemic and War
Expressions like “migraon crisis”, “migraon problemac” or even “migrant’s invasion” have lled the media in the last dec-
ade, brought the subject into our daily lives and made almost everyone coin a personal opinion based on dierent amounts
of data or informaon about it. But with no doubt, ethics scholars as well as general public had to rethink and mostly re-
frame their consideraons about this topic with the arrival of two unprecedented stormy events: the COVID-19 pandemic
and the massive refugee inux caused by the war in Ukraine.
We sadly have to admit that the internaonal state system aords freedom of movement and residency rights to individuals
in inverse proporon to the degree that they need them. Those with power and resources can – in ‘normal’ mes – easily
circulate between the world’s countries, while the impoverished and oppressed – including those who count as refugees
under internaonal law – face severe, life-threatening obstacles to nding liveable condions. This situaon arises from a
system that gives states a rather discreonary power over who to admit onto their territory.
One deeply regreable feature of the polical world we inhabit is that, while everyone supposedly has a human right to seek
and to enjoy in other countries asylum from persecuon, in pracce many people seek asylum and do not nd it.
The discussion about rights and dues surrounding migraon and freedom to travel is not new. But the mobility restricons
deployed against COVID-19 forced many people otherwise unaected by border controls to confront the irritang queson
of who gets to move and why. The pandemic has call aenon to the many reasons, from care to subsistence and the intrin-
sic value of feeling unrestricted.
Many people that would have never imagined having any restricon of their freedom of moving had faced for their rst me
the weird disrupons and reconguraons that have occurred in our daily life since the emergence of COVID-19. Beyond the
medical consequences that implied wearing PPE, over demands to healthcare workers, social distancing, lockdowns, some
other social phenomena became central. Sgmasaon; data control, inaccurate informaon, exacerbaon of racism, vac-
cines distribuon, and polical use of this uncanny outbreak, took shape in responses and reconguraons in this new world
conguraon. In the specic realm of migraon, pandemic mes worsened the already dramac experience of migraon
adding considerable anxiety and fears about the future. The closure of borders, restricon of travel and suspension of most
internaonal ights has completely altered the environment through which migraon occurs and migrant lives can be estab-
lished and sustained. While most governments have permied the return of cizens and those with long-term residence
rights, the fate of irregular migrants, asylum seekers, refugees, and guest workers made the condions of survivability much
more dicult and unstable by new restricons. Addionally asylum seekers face another pause in the staggered and delayed
process of gaining legal recognion; refugees are considered bioethical risks and were subject to enhanced restraint proce-
dures; and guest workers lost their precarious informal jobs and any source of revenue but neither permied to travel to
countries where they lived.
At the same me, the public health crisis dramacally worsened pre-exisng trends towards more restricve and repressive
modes of enforcement, including a mass shutdown of borders ; a remarkable expansion in state surveillance and a spike in
xenophobia and racism; all at a me when the economic and polical circumstances are pushing millions across the globe
into poverty and uer vulnerability.
In facing the news about the dramac situaon of migrants, general public comfort themselves with the idea that this situa-
on is limited to those trying to enter illegally to some countries and that people in real danger of current persecuon get
their refugee status and may achieve a lawful freedom. With that perspecve, there is nothing “unfair” in restricng the in-
ux of the so-called “illegal migrants” who cannot formally qualify as refugees. But during the last years, the global refugee
crisis has caused many relavely wealthy Western states to see a dramac upck in the number of people arriving on their
territory to claim asylum. While there is a general agreement that these states have some obligaon to refugees and asylum
seekers, which precise obligaons the states have is far from being established. It is not uncommon to hear that this obliga-
on is considered a duty to rescue refugees from the harms created by their home countries. But what the duty to rescue
refugees requires from relavely wealthy Western democracies for them to be able to say that has done its fair share is an
unanswered queson.
Humanitarian News
W A B I P N E W S L E T T E R P A G E 11
Far from the ethical and legal discussion in internaonal fora or academic environments, in the real world the gures show
that , as relavely wealthy countries are very unlikely to accept all the refugees that claim for asylee, the best of the oered
soluons is to “be rescued” in a refugee camp and wait for a legal permission to be relocated in other country, a permission
which may be conceded or not. When we talk about a refugee camp, we mean the temporary selements that are set up by
the UNHCR to receive those who have le their countries, eeing from persecuon, war, or other forms of conict. Their
goal is to aend to the immediate needs of refugees who are seeking help by providing security, food, water, and medical
care.
But the problem with refugee camps occurs when ‘temporary’ camps intended to help with immediate needs become long-
term selements. Refugees are given raons and a place to live but are usually not permied to work or move around with-
in the country. Refugee camps are oen places of insecurity and abuse, imposed idleness and reduced autonomy, and hold
very lile hope of seeing something beer in the next future. As pointed out for McDonald-Gibson, a refugee camp is emo-
onally too close to be in jail, pung your life on pause, receiving just enough food and water to survive, but with no chance
at all to provide for a family or plan for a future.
In the 21st century, only about 1% of refugees will be reseled in a given year, 2% will be able to return home, and the vast
majority will spend on average 17 years as a refugee either in a camp or informally in a city with lile access to internaonal
aid. The 10% of refugees who seek asylum directly in the West must risk their lives, overcome brutal restricon policies and
spend their whole life savings just to survive those perilous trips.
Given the condions in a refugee camp, it is understandable that many refugees reject them and increasingly choose to go
to cies, where they live informally (that is, without being formally registered with the UNHCR or the local government).
That behavior has some advantages as they maintain their freedom of movement, can live where they want and can come
and go freely. But they pay it with the huge disadvantage of not receiving assistance from the internaonal community in
terms of housing, food, health care or educaon when they are outside of refugee camps. As an example, fewer than 1 in 10
Syrian refugees in Turkey, Lebanon and Jordan receive any material support from the UN or its partners. Though help with
food, health care and educaon may not be adequate in camps, the virtual absence in urban centres can be devastang.
Even when many refugees are able to nd some work, it is oen well below what is needed to survive, forcing refugees to
ask for some help from their children adding some small income. This in turn results in insurmountable barriers to going to
school. According to Amnesty Internaonal most of Syrian refugee children in Turkey remain without access to primary edu-
caon.
Some authors argue that thinking about moral obligaons purely in terms of dues of rescue obscures the role that rescuing
states have played in creang and sustaining the condions of violence, insecurity and poverty in their countries of origin
and (directly or indirectly) have contributed to many of the harms that refugees experience as they seek refuge. The role of
the Western states (that are so proud of being the strongest democracies in the world) is not solely one of rescue, but of
creators and supporters of a system that helps few, harms some and makes it nearly impossible for most of them to access
the minimum condions for human dignity
If we accept the reality that many states are unlikely to accept as many refugees as they ought, though some refugees will be
admied, many with rm claims will be wrongfully rejected. Are some ways of wrongfully rejecng refugees less objecona-
ble than others? Is then morally jusable to give priority to refugees who ee from worse forms of discriminaon or perse-
cuon or any other kind of “priorizaon”? If guided by the internaonal law rules, we should not be primarily concerned
about refugees arriving in recipient states that formally apply for asylum. If those cases the queson about ‘priories should
become a queson about clearly dening the principles that determine who is granted the legal status of a refugee and who
should receive asylum and consequently all those lling the requirements, should be accepted. Which also means that if a
state grants someone the legal status of a refugee under internaonal convenons, then it would be illegal to deny the per-
son asylum based on any extra consideraons of priorizaon.
However, we have to face the uncomfortable queson about which real and varied factors impinge on the recepon of refu-
gees Or even more dramacally told: are some refugees more worthy than others?
Since 2011, more than six and a half million people—from Syria, Afghanistan, Venezuela, Eritrea, and other countries—have
sought asylum in Europe. Naonalists across the Connent have made anpathy toward such migrants a cornerstone of
their agendas. Refugees have even been called “Muslim invaders.” In Poland, in 2021 migrants and asylum seekers (most of
Humanitarian News
W A B I P N E W S L E T T E R P A G E 12
them from Iraq and Afghanistan, trapped on Belarus's borders with Poland and Lithuania) tried to cross its border with Bela-
rus and were brutally pushed back by security forces with water cannons and tear gas. However, we can see that aer the
conict in Ukraine most of the European Union polical leaders have said publicly that refugees from Ukraine are welcome
and countries have been preparing to receive refugees on their borders with teams of volunteers handing out food, water,
clothing, and medicines. Slovakia[and Poland have said that refugees eeing the war in Ukraine will be allowed to enter their
countries even without passports, or other valid travel documents; other EU countries, such as Ireland, have announced the
immediate liing of visa requirements for people coming from Ukraine. Even free public transport and phone communica-
on is being provided for Ukrainian refugees. Legal reforms are being prompted that may allow refugees from Ukraine be
oered up to three years temporary protecon in EU countries, without having to apply for asylum, conceding rights to a
residence, permit and access to educaon, housing, and the labour market
Of course, facing such a huge crisis as this war is, that generous collaboraon is welcome and perfectly understandable. The
horric situaons created by the Russian invasion to Ukraine turned thousands and thousands of people into refugees from
one week to the other, triggering one of the largest and fastest refugee movements that Europe has witnessed since the end
of World War and the one of the largest humanitarian crisis that Europe has seen. But we should remember that it was not
so long ago that the connent faced another crical humanitarian challenge, the 2015 refugee "crisis" spurred by the conict
in Syria.
The current refugees eeing from Ukraine made their way to the borders of Poland, Slovakia, Romania, and Hungary. But
unlike many others who, over the past decade, have sought to escape conict and oppression by eeing to European coun-
tries, they were welcomed inside. We have heard (and found it natural?) some reporters covering the war saying “These are
not refugees from Syria. . . . These are Chrisans, they are white, they’re very similar to the people that live in Poland.” Or
referring to Kyiv, “With all due respect, these people do not come from Iraq or Afghanistan or Syria, they come from a rela-
vely civilized, relavely European city.” We have also witnessed that the non-European refugees from Ukraine (thousands
of Africans living in Ukraine, mainly students), struggled to enter Poland and other countries as refugees being violently
stopped by the Ukraine authories at the border or unwelcome in any of the receiving countries.
This current scenario obliges all of us as mankind to reect on the uerly dierent responses the Western world has had at
these two situaons of “humanitarian crisis”. It should provide a cauonary lesson for those hoping for a more humane, gen-
erous Western democracies. This is indeed how the internaonal refugee protecon regime should work, especially in mes
of crisis: countries keep their borders open to those escaping wars and conict; temporary eliminaon of unnecessary iden-
ty and security checks; permission to arrive without valid identy and travel documents; and of course, no detenon
measures or impediment to freely join family members in other countries. Communies and their leaders should always
welcome refugees with generosity and solidarity.
Bes and Collier argue that providing refuge ‘is about fullling our duty of rescue’. According to them, the duty of rescuing
refugees is born out of a common humanity that we share with other human beings. It creates moral obligaon to assist
strangers who are in desperate need when we can do so at no signicant cost to ourselves, so, the well-known principle of
the Good Samaritan. An the parable of the Good Samaritan points out that there is no connecon between the rescuer, the
Samaritan, and the person in need of help; the Good Samaritan simply helps out of human decency, not because they were
responsible for harming the person lying by the side of the road.
On the one hand, we are urged to confront the uncomfortable electoral reality of widespread public hoslity towards great-
er immigraon, and the increasing acceptance of the immense suering caused by real-world border enforcement pracces
and the undisputable racism that lays under those “public opinions”. It implies that how ambious the migraon and asylum
law reforms should be in order to fulll the moral call will be a maer of vigorous dispute at a me when fundamental as-
sumpons about movement and membership are in queson.
However, it should be considered that the world today is parcelled up between sovereign states whose legimacy derives
from their role in protecng the human rights of those individuals within their territory. Owen argues that the mere exist-
ence of refugees is always evidence that some states are failing in their role, requiring internaonal society to oer subs-
tute protecon. In his words, the instuon of refugeehood acts as a ‘legimacy repair mechanism’ that rearms ‘the mini-
mal condions of the imagined reconciliaon of an internaonal order of sovereign states and a cosmopolitan order of hu-
man rights’. It means that the protecon of refugees not only answers to the morally urgent need of the world’s most vul-
Humanitarian News
W A B I P N E W S L E T T E R P A G E 13
nerable groups; it funcons as a global ‘public good’ from which all states benet in terms of their legimacy.
The Ukraine refugee crisis presents the Western countries with not only an important opportunity to demonstrate their gen-
erosity, humanitarian values, and commitment to the global refugee protecon regime; it is also a crical moment of reec-
on: it is the moment to analyse if the peoples all over the world may be able to overcome their widespread racism and ani-
mosity and make the universalist spirit of the 1951 Refugee Convenon something more that worthless pages. In fact, the
Arcle 3 of the Convenon is quite explicit when saying that all member states "shall apply the provisions of this Convenon
to refugees without discriminaon as to race, religion or country of origin." We have to face the atmosphere of the moment
and respond ourselves truthfully if all the internaonal organisaons, internaonal convenons and laws, really rule our
global connivance or are just decorave disrespected documents to be ridiculed or manipulated by the social actors holding
the real power.
Many humanitarians doubt that the current change in mood toward refugees escaping Ukraine will aect the migrants risk-
ing their lives on the Mediterranean. It may be too late to undo the damage of strong xenophobic polics. But the triumph of
exclusionary naonalism is by no means inevitable. The COVID-19 has provided undeniable evidence of humanity’s shared
vulnerability and interdependence. We should have learnt that the enre world is our neighbourhood and that nobody can
get security and salvaon by his or her own. The hope is that seeing so clearly the double standards applied to migrant and
asylum seekers and having understood our interdependence just as members of the human race, we will be able to
acknowledge that the current status quo is deeply unfair and revisit some fundamental principles regarding border controls.
References:
1. Beitz C. 2011. The Idea of Human Rights. New York: Oxford University Press.
2. Bes A et al. 2017. Refuge: Rethinking Refugee Policy in a Changing World. Oxford: Oxford UP
3. Aitchison G. Ethics & Global Polics. 2021: 14:1
4. Cherem MG . Ethics & Global Polics, 2020:13:1, 33-49, DOI: 10.1080/16544951.2020.1735018
5. May L. 2011. Global Jusce and Due Process. Cambridge: Cambridge University Press.
6. Owen D. Moral Philosophy and Polics 3. 2016: (2): 141–164
7. Parekh P. Ethics & Global Polics. 2020: 13:1, 21-32
*The views expressed in this arcle are those of the author (Silvia Quadrelli) and do not necessarily reect the ocial posi-
ons of the Execuve Board or Internaonal Board of Regents of the WABIP.
Best Image Contest 2023 (1 of 3)
Descripon:
Endobronchial Rhinosporidiosis
A. Tracheal mucosal inltraon with strawberry like growth
B. Complete occlusion of right main bronchus due to endobronchial growth
C. Endoluminal growths in bilateral main bronchi
D. Histopathological image Mature spoprangia with thick chinous wall containing mulple endospores
Submiers:
Pree Vidyasagar, Harikishan Gonuguntla
Best Image Contest
P A G E 14
This image is 1 of 3 selected among 100+ submissions to our Best Image Contest held in late 2022. Our next
Image Contest will open later this year. We look forward to receiving your image submissions.
P A G E 15
WABIP News
Intervenonal Pulmonology Instute of the WABIP in Turkey is Coming Soon
The rst Intervenonal Pulmonology Instute (IPI) of the
World Associaon for Bronchology and Intervenonal Pul-
monology (WABIP) will inaugurate in May 2023 at the LIV
hospital, Istanbul. The innovave idea of teaching and
training in Intervenonal Pulmonology to doctors from
around the globe was created and movated by Prof. Ali I.
Musani. His novel concept is poised to gather internaonal
fellows and the WABIP faculty to the rst IPI at the Liv
Hospital.
We look forward to launching the Instute on February
25th, 2023, with an “Advanced Bronchoscopy Confer-
ence.” The Inaugural meeng will oer a comprehensive program on advanced diagnosc and therapeuc bron-
choscopy. The president of the WABIP, Stefano Gasparini; head of Instutes Ali Musani; and other disnguished
internaonal and local faculty will visit the Liv Hospital and discuss nal plans with the leadership of the Liv hospi-
tal. Aer this meeng, WABIP and Liv Hospital will ocially sign the contract that will connect the world’s largest
internaonal organizaon of intervenonal pulmonologists and a private hospital system to democraze
knowledge, healthcare, and science for all the worlds.
The fellowship program of instute will accept its rst fellow in the summer of 2023. The curriculum and fellowship
selecon commiee chairs, Lorenzo Corbea (Italy) and Javier Flandes (Spain) are working hard at nalizing the
tasks assigned to their commiees. Fellowship applicants can send their inquiries to Dr. Dalar at Levent-
dalar@gmail.com and Dr. Flandes at jandes@quironsalud.es
We look forward to a new beginning in Intervenonal Pulmonology on the Global Horizon.
Levent Dalar MD.
Site Director IPI, LIV Hospital, Istanbul.
WABIP Vising Scholar Travel Grant Connues
I am very proud and happy to be a recipient of the WABIP
Vising Scholar Travel Grant, being awarded this honor
back in 2019. Prof. Venerino Pole from Italy had caught
my aenon as I was reading his papers and book on
Transbronchial Cryobiopsy, Intersal Lung Diseases and
other intervenonal procedures. I was very gracious to
have the professor and his colleagues accept me as a train-
ee, but then the pandemic hit, and it forced me to delay
my training.
Finally in 2022 when the severity of the pandemic had
greatly decreased, it was nally my opportunity to revisit
the WABIP travel grant awarded to me years earlier. I con-
tacted Professor Pole again, and started to make ar-
rangements for my training.
Dr. Sangit Kasaju (trainee), Prof. Venerino Pole, Prof. Claudia
Revaglia
P A G E 16
WABIP News
I have arrived GB Morgagni Hospital, Forli, Italy in rst week of December 2022. I was amazed by their bronchoscopy
suits ( Endoscopia toracica). I have able to meet other faculty members, residents, nurses and whole team. I have found
out that Professor Venerino Pole is very famous clinician here and this hospital is referral center in Bologna region.
They have been so kind and extremely helpful. I am also amazed to see volumes and variees of cases they handle. On
my rst day I have able to seen and have assisted Cryobiopsy, EBUS, Transesophageal bronchial biopsy; Bronchial lavage,
Rigid and Flexible bronchoscopy. I have seen total le side lung lavage for pulmonary alveolar proteinosis, which is rare
lung diseases and this procedure is only done in this hospital in this region according to doctors here. I have been im-
pressed also with their ecient and dynamic team here and they have been making complex procedures so simple.
This did inspire me a lot. I able to do even exible bronchoscopy and bronchial lavage on my own on my second day,
guided by them. I have also aended mul disciplinary grand rounds together with whole facules, pathologists , radiol-
ogists. They presented cases even in english just for me although they used to do in Italian language usually. I am seeing
very interesng cases scheduled for coming weeks for procedures. These cases excite me a lot. and even I’m wishing if i
can extend for longer duraon so I can learn at depth.
I would like to thank WABIP for granng me this grant, Prof Henri Colt past Chair of WABIP for vising NCCP, interna-
onal congress in Nepal and encouraging me to establish NABIP aliated with WABIP and Professor Venerino Pole,
Professor Claudia Revaglia and whole team for making my stay wonderful learning experience. I hope I can reciprocate
knowledge I gained here to my colleagues in Nepal and I do believe my fellow countrymen will surely benet from this.
Thank you!
Sangit Kasaju, M.D. (Nepal)
WABIP Vising Scholar Awardee
P A G E 17
Education
First WABIP/Chile Intervenonal Bronchoscopy Workshop
On December 5th and 6th, the very rst WABIP acvity in Chile was held. This was the 3rd aempt to organize a WABIP/Chile
event that was repeatedly delayed because of the epidemiological condions. Happily, nally pandemia has given us a break
to gather our colleagues who were eagerly expecng this educaonal event at the Centro Cultural El Tranque, one of the most
selected facules in Lan America and Europe. That Centre is a modern, fully equipped and with a permanente sta trained to
support and provide the best logisng for surgical and endoscopical procedures simulaon.
With the great support of Clínica Meds and the new Chilean IB center, we did a theorecal / hands-on course focused in ad-
vanced techniques, that included: EBUS, rigid bronchoscopy, laser ablaon, metallic and silicone stenng and cryobiopsy. In
this last technique, we had the honor to receiving the invaluable presence of one of the most important gures in this eld,
Dr. Sara Tomasse from Florence, Italy. An outstanding teacher who shared her experse with paence, sophiscated educa-
onal skills and incredible kindness.
Sara Tomasse sharing her experse
As an organizer I’m very thankful of the kind and uncondional parcipaon of our internaonal professors:
• Dr. Artemio García (Argenna)
• Dr. Fernando Monge (Perú)
And the none less important support of our great local Chilean faculty:
• Dra. Macarena Rodríguez
• Dr. Arturo Morales
• Dr. Felipe Undurraga
• Dr. Alfredo Jalilie
P A G E 18
Education
Some of the regional instructors of the WABIP workshop in Chile
Artemio García, a regular reless instructors in so many WABIP hands-on sessions.
The event was very successful and all our aendees (mainly bronchoscopists with an intermediate level of previous train-
ing) found the experience not only very useful but also incredibly inspiring to increase their own interest in bronchoscopy
and in training other colleagues themselves. I hope that this was the rst of many future events of cooperaon between the
Chillean bronchoscopists and our worldwide Associaon . We pledge to acvely work to help WABIP to grow and get
stronger to be able to give this same opportunity to many of our colleagues all around the world.
P A G E 19
Education
Several staons fully working in the hands-on pracce of dierent techniques.
We nally render thanks to WABIP and its Execuve Board for the unlimited support they permanently show for the bron-
choscopy educaon. The reless work of the WABIP leadership made this possible in spite of the incredible obstacles
posted by the pandemic.
Dr. David Lazo P.
Director First WABIP/Chile Intervenonal Bronchoscopy Workshop.
Chile Regent
P A G E 20
Education
WORKSHOP WABIP IN ECUADOR
Celebrang the return of the onsite acvies, WABIP has re-started its tradional training programs.
Dr. Rocío de Janon, Regent of the Ecuadorian Society of Tisiology and Thorax Diseases, organized and chaired a
wonderful workshop with very acve hands-on sessions. The event occurred on November 17-18, 2020 in one of
the largest hospitals in the country, Hospital de Especialidades Teodoro Maldonado Carbo in Guayaquil city,
where Dr. De Janon (as a Chair of Respiratory Medicine) and her group have developed a compelling bronchosco-
py unit.
The organizing team with the instructors
This II Bronchoscopy course-workshop, sponsored by WABIP and the Ecuadorian Society of Tisiology and Thorax
Diseases had the parcipaon of 30 specialists in respiratory medicine who are already working in bronchosco-
py and who have a basic or intermediate level of previous bronchology training.
WABIP gathered for this very meaningful educaonal event some of its most experienced instructors: Dr. Fabien
Maldonado (USA), Artemio García (Argenna), Marco Solís (Bolivia) and Silvia Quadrelli (Argenna).
Aer the didacc lectures in the morning, aendants worked at dierent staons, including exible bronchosco-
py, cryobiopsy, rigid bronchoscopy, EBUS and convenonal TBNA .
Every single parcipant had the opportunity to pracce each technique in the dierent inanimate models under
the meculous guidance of the instructors.
A great experience, beaufully organized by Dr. De Janon's team and highly valued by all parcipants, which al-
lowed everyone to get in contact with the WABIP experts during 2 full days, in a warm ambiance of comradeship,
curiosity and enthusiasm.
WABIP thanks the enormous eort made by the organizing team and the invaluable contribuons of its instruc-
tors, who selessly help the Associaon to disseminate bronchoscopy training throughout the world in order to
create safer, more reliable and fully comfortable procedures for every paent in every country.
P A G E 21
Education
Dr. Fabien Maldonado teaching rigid bronchoscopy
Dr Artemio García working at the EBUS staon
Marco Solís Dr training in cryobiopsy
P A G E 22
Education
Workshop of Advanced Diagnosc and Therapeuc Bronchoscopy in High Fidelity
Cadaveric Models in Uruguay
On November 29th WABIP co-sponsored, with the Uruguayan Society of Pneumology, the rst bronchoscopy workshop
with high delity cadaveric models in Uruguay.
The acvity occurred in Maciel Hospital, one of the oldest naonal statal school hospitals in Montevideo, with the par-
cipaon of presgious internaonal professors: Dr. Juergen Hetzel from Germany and Dr. Artemio Garcia from Argen-
na.
Almost 30 pulmonologists and thoracic surgeons with basic bronchoscopy skills parcipated in enhancing their training
to create safer, more reliable, and fully comfortable bronchoscopic procedures.
Special thanks to the enormous eort made by the organizing team and the invaluable contribuons of its local instruc-
tors (Dr. Nicolas Arechavaleta, Dr. Eduardo Quintana, Dra. Ana Gruss from The Pneumology Department at the Faculty
of Medicine and Dr. Wiliam Bapsta, Dr. Manuel Da Fonte and Dr. Florencia Picaroni from The Clinical Simulaon Unit
of the Uruguayan Society of Anesthesiology), who selessly helped to disseminate bronchoscopy training.
The List of Bronchoscopic Therapies Goes On!
Bronchoscopic Treatment of Chronic Bronchis - Bronchial Rheoplasty!
Chronic Bronchis is a chronic, progressive disease with debilitang symptoms. Medical management of this disease is oen unsuccessful. Several
innovave bronchoscopic treatments focused on the ablaon and destrucon of hypertrophied submucosal glands and hyperplasc goblet cells
are being tested in animal and human models. Some therapeuc modalies include liquid nitrogen metered cryospray and Bronchial Rheoplasty
(BR). Another modality with a slightly dierent mode of acon being tested is targeted lung denervaon (TLD), which aims to decrease the release
of acetylcholine, which regulates smooth muscle tone and mucus producon by ablang the parasympathec nerves along the main bronchi.
These modalies are at dierent stages of clinical trials and promise decreased exacerbaon frequency, reduced chronic bronchis symptoms, and
improved quality of life.
Bronchial Rheoplasty uses an endobronchial catheter deployed through the working channel of a exible bronchoscope to apply nonthermal
pulsed electrical elds to the airways. Each lung is treated at a dierent me, approximately one month apart.
Recently, a study published in the American Journal of Respiratory and Crical Care Medicine (1) established the safety and ecacy of Rheoplasty
in paents with severe chronic bronchis. In this study, two prospecve, mulcenter, single-arm clinical studies under two nearly idencal proto-
cols recruited paents at ve terary academic centers in Austria, Australia, and Chile.
Bronchial Rheoplasty was performed in all 30 paents, with a mean age of 67; mean postbronchodilator FEV of 65%; mean COPD Assessment Test
score of 25.6; mean SGRQ score of 59.6. There were no device-related and four procedure-related serious adverse events through 6 months, and
none aer that through 12 months. The most frequent nonserious, device- and/or procedure-related event through 6 months was mild hemoptysis
in 47% (14 of 30) paents.
Histologically, the mean goblet cell hyperplasia score was reduced by a stascally signicant amount (P < 0.001). Signicant changes from baseline
to 6 months in COPD Assessment Test (mean, −7.9; median, −8.0; P = 0.0002) and SGRQ (mean, −14.6; median, −7.2; P = 0.0002) scores were ob-
served, with similar observaons through 12 months. The histological ndings, as shown in g 1 (1), show a signicant reducon in the number of
epithelial goblet cells, parcularly in those paents with pretreatment evidence of moderate-to-severe goblet cell hyperplasia.
Editor-in-Chief: Dr. Kazuhiro Yasufuku
Research
Primary Business Address:
Kazuhiro Yasufuku, Editor-in-Chief WABIP
Newsleer
c/o Judy McConnell
200 Elizabeth St, 9N-957
Toronto, ON M5G 2C4 Canada
E-mail: newsleer@wabip.com
P A G E 23
Associate editor:
Dr. Ali Musani
Associate editor:
Dr. Sepmiu Murgu
Ali I. Musani MD, FCCP
University of Colorado School of Medicine,
Denver
This study provides proof of concept and the rst clinical evidence of the feasibility, safety, and inial outcomes of BR in symptomac pa-
ents with chronic bronchis. This study has limitaons, including a small sample size and a lack of a control group. Therefore, large, ran-
domized, and prospecve studies are required despite clinical and histologic evidence supporng improvements.
Reference:
1. Valipour A et al.; J. Am J Respir Crit Care Med. 2020 Sep 1;202(5):681-689. doi: 10.1164/rccm.201908-1546OC. PMID: 32407638; PMCID: PMC7462406.
Research
P A G E 24
Figure 1. Histological ndings from the right bronchus intermedius of a study paent.
The goblet cells, with magenta-colored cytoplasmic mucin highlighted by periodic
acid–Schi staining, are seen in the supercial bronchial epithelium. (A) On
Day 0, immediately before therapy, signicant goblet cell hyperplasia can be
seen (score of 2). (B) Right bronchus intermedius 120 days aer the
inial treatment, demonstrang complete regeneraon of the pseudostraed
columnar epithelium with a reducon of goblet cell numbers (semiquantave
assessment score of 1).
*This gure was used with permission from the American Thoracic Society .
P A G E
25
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 25
