Cryotherapy in interventional bronchoscopy is a new treatment modality which has recently been made available for the pediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this work was to elaborate on the application progress of cryotherapy in pediatric pulmonary diseases and also to assess indications, success rates, and complications of airway cryotherapy in children. In summary, cryotherapy via flexible bronchoscopy is a safe and feasible method. The application scope in pediatrics is similar to that in adults, and it is mainly used in airway obstructive diseases. However, it is primarily caused by benign conditions, and the interventional treatment mainly seeks to provide long-lasting symptomatic alleviation. Thus, prevention, treatment, and prognosis of long-term complications are issues that should be carefully considered in pediatric applications.

Invasive Necrotizing Tracheobronchial Aspergillosis in Children: A Case Series and Literature Review - Article abstract #950588

The intricate airway anatomy and poorly understood etiology of pediatric conditions render the diagnosis of mediastinal disorders particularly challenging. Traditional diagnostic methods, such as mediastinoscopy and thoracotomy, carry high risks and are often impractical in children. Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) enables a minimally invasive, esophageal route to mediastinal lesions, providing a diagnostic approach that is new to pediatrics compared with conventional techniques. We review the technical characteristics, clinical benefits, and prospective role of EUS-B-FNA in pediatric diagnostic investigation. We also review the clinical applications of EUS-B-FNA to date and aim to promote its use as a novel adjunct for the evaluation of complex mediastinal pathology in pediatric medicine.

Introduction: Managing recurrent congenital tracheoesophageal fistula (rTEF) is clinically challenging. Repeat thoracotomy is technically demanding due to dense adhesions and carries high morbidity, whereas outcomes of conventional endoscopic interventions vary, and sustained closure may be difficult to achieve in complex recurrent fistulas. We report the use of bronchoscopy-guided intratracheal suturing in a refractory case. Case Presentation: A 17-year-old male with a history of congenital TEF experienced multiple recurrences despite two thoracotomies and one endoscopic clipping attempt. The procedure was performed under general anesthesia without endotracheal intubation, and superimposed high-frequency jet ventilation was used for airway management. Following electrocautery treatment of the visible tracheal-side margins, four interrupted absorbable sutures were placed through tissues adjacent to the fistula opening under bronchoscopic guidance. Tightening of the sutures approximated the visible fistula margins. The procedure lasted 62 min with no complications. Follow-up bronchoscopy, methylene blue testing, and esophagography at 2 weeks showed no evidence of fistula leakage, indicating early technical closure. At the 3-month telephone follow-up, the patient remained asymptomatic and reported normal oral intake and physical activity. These findings suggest early technical success; longer objective follow-up is required to assess durability. Conclusions: In this highly selected adolescent, bronchoscopy-guided intratracheal suturing was technically feasible and achieved early fistula closure without a perioperative complication. Longer objective follow-up after loss of suture tensile strength is required to determine whether closure can be maintained without mechanical suture support.