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
Educaon 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 aendees to
create new friendship, learn in
the most smulang way and
know the history and the past
and present of one of the most
famous medical instuons in
the world.
We are sure that all the Congress
aendees share the same gra-
tude the WABIP-WCBE leader-
ship expresses for such a suc-
cessful conference and such a
fantasc 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, Argenna
Vice-chair, WABIP
Every other year, the World Con-
gress Joint Meeng of the World
Associaon for Bronchology and
Intervenonal Pulmonology
(WABIP) & The Internaonal
Bronchoesophagological Society
(IBES) 2018 provides internaonal
parcipants unmatched opportu-
nies to exchange scienc ideas
& research in bronchology and
intervenonal 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 applicaons 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 excepon of this
long tradion 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, obstrucve lung dis-
ease, lung nodules, intersal
lung diseases or tuberculosis were
studied from the perspecve of
dierent countries and bringing
management opons for the
dierent contexts and the dier-
ent availability of technology. Di-
dacc lectures, interacve ses-
sions and expert panel discussions
allowed to discuss the newest
ndings in airway diseases. Hands
-on workshops gave the oppor-
tunity to pracce the dierent
intervenonal procedures guided
by experts in bronchoscopy edu-
The excellent conference venue
oered by the Mayo Civic Centre
was the perfect scenario for this
internaonal conference. The am-
ple and comfortable facilies, ide-
al for educaonally focused
events as our World Congress cre-
ated a wonderful ambiance to
exchange ideas, discuss scienc
trends, and explore soluons to
the old and new challenges in
The 20
WCBIP Congress Presi-
dent (Eric Edell) and the WCBE
President (Dr. Jan Kasperbauer)
did a wonderful job that sur-
passed all the expectaons. A
complete and varied academic
program, an outstanding organi-
zaon 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
Silvia Quadrelli MD
Buenos Aires,
Argenna, Chair
Hideo Saka MD
Nagoya, Japan,
Zsolt Papai MD
Hungary, Immediate
David Fielding MD
Brisbane Australia,
Guangfa Wang MD
Beijing, China,
President WCBIP 2020
Philip Astoul, MD
Marseille, France,
President WCBIP 2022
Michael Mendoza
General Manager
Judy McConnell
Kazuhiro Yasufuku
Newsleer Editor-in-
P A G E 2
World Congress Joint Meeng of the World Associaon for Bronchology and
Intervenonal Pulmonology (WABIP) & The Internaonal
Bronchoesophagological Society (IBES) 2018
Technology Corner
Near-infrared imaging during VATS with transbronchial injecon of ICG
Yasuo Sekine, MD, PhD
Professor, Department of Thoracic Surgery
Tokyo Women’s Medical University Yachiyo Medical Center
Introducon: Recent advances in CT screening has resulted in the increase of early stage lung cancer detecon, specically small
peripheral lung cancer. Various methods of intraoperave localizaon of such small nodules during minimally invasive surgery have
been reported. Furthermore, pulmonary sublobar resecon has been recognized as an operave opon for complete resecon of
these early stage lung cancers [1] and metastac lung tumors. Sublobar resecon is ideal for preservaon of lung parenchyma,
pulmonary funcon, with lower perioperave morbidies and can be applied for surgical manage;;@L-H<<@<1">dional primary lung
cancers that may develop afgter inial resecon. Recent surgical topics in lung neoplasms are how to manage a non-palpable small
nodule in the peripheral or intermediate poron and how to maintain adequate surgical margins during sublobar resecon. To
answer these quesons, the establishment of precise tumor marking method as well as anatomical sublobar resecon with meas-
urable surgical margin is crucial.
Background: The standard approach for anatomical lung segmentectomy is vascular and bronchial transecons followed by divi-
sion of intersegmental planes. However, this method has several obstacles especially in complex segmental resecon. The iden-
caon of segmental bronchus and associated vessels is somemes dicult and intraoperave inaon of the lung can be a chal-
lenge during thoracoscopic surgery. Although the conrmaon of an appropriate resecon 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 localizaon of small sized pulmonary nodules are microcoil or hook wire implantaon and dye marking
by CT guidance or transbronchial inseron. However, these methods are somemes me consuming, technically challenging, may
require high cost and may induce rare but severe complicaons.
We previously developed and reported a novel approach for performing segmentectomy by using a Near-infrared thoracoscopy
with transbronchial insllaon of indocianine green (ICG) [C]. We improved this method by combining with the most advanced
computer technology of making virtual sublobar resecons and established a precise anatomical sublobar resecon with enough
surgical margin. This method can also serve both as tumor localizaon marking and anatomical super deep wedge resecon for
early stage lung cancers and metastac lung tumors.
Clinical applicaons: There are two types of ICG idencaon in ICG-guided segmentectomy [3,4]. One is negave staining by
intravenous injecon of ICG aer pulmonary arterial division [3]. The other is posive staining by transbronchial insllaon of ICG
before operaon [4]. The surgical step of negave staining is basically the same with tradional approach, vascular and bronchial
transecon followed by segmental division aer ICG i.v. injecon. On the other hand, posive staining is simultaneous process of
vascular and bronchial division and segmental division because of possible inial idencaon of segmental planes.
In negave staining, aer vascular and bronchial divisions, 0.25 mg/kg of ICG is intravenously injected. Soon aer injecon, ICG
uorescence is visualized in circulated area. Therefore, ischemic area, which is the segments to be resected, is not stained. Alt-
hough this condion connues for only 60 to 90 seconds because of quick circulatory distribuon, ICG injecon can be done re-
In posive staining, before operaon, 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 inslled into
each associated bronchus. ICG is connuously remained in the segmentectomy area. ICG staining connues for several hours.
Therefore, we can conrm resecon area at any me during operaon and conrm vessels and bronchus to be divided (Fig. 2).
P A G E 3
Furthermore, we created anatomical super deep wedge resecon 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 eecve because the depth cannot be speculated. In these
cases, virtual sublobar resecon is created in order that the nodule is placed in the center of simulated resecon area (Fig. 3). Then, ICG is
inslled in the same manner. Anatomical deep lung wedge resecon is possible by dividing the lung along the ICG borderline without indi-
vidual vascular transecon with enough surgical margin (Fig. 4). In parcular, this procedure can conrm central surgical margin, because
all removal area is displayed by uorescence.
Conclusion: Transbronchial ICG insllaon and ICG-guided sublobar resecon is feasible for early stage lung cancers and metastac lung
tumors. This method can be applied to tumor localizaon and is also useful for assuring good surgical margin during complex sublobar re-
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
paents with metastac 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 resecon (ASDWR). The
nodule is located in S1+2cii and S3ai. To obtain enough margin, S4ai is added. This bron-
chus is a sixth bronchial bifurcaon counng 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 localizaon 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 paents with various intrathoracic
lesions, BAL has been used to assess inammaon in paents with lung infecons, cancer, exposure to toxic substances, asthma, and chron-
ic obstrucve pulmonary disease, as well as to support or exclude causes of alveolis, monitor the status of lung allogras, help diagnose
illnesses such as hisocytosis, pulmonary alveolar proteinosis, peripheral lung cancer, asbestos-related lung disease, and berylliosis, and
monitor uid cell dierenals in paents with intersal lung disease. Furthermore, translaonal research studies of BAL uid, including
studies of surfactant, inammatory proteins, cellular dierenals, serum molecules and proteomics/gene expression have increased our
understanding of lung inammaon and pulmonary injury/repair processes in adults and children. In both healthy individuals and paents,
BAL ndings are inuenced by degree of atopy, age, smoking status and underlying pulmonary condions (1).
Because alteraons in BAL uid and cells reect alteraons in lung parenchyma, careful aenon must also be paid to sampling procedures,
specimen processing, and precise analysis of cell dierenals. 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, inslling several aliquots of isotonic saline soluon (warmed to room temperature) in a way that ‘oods” target bronchial and bron-
chioloalveolar territories, and retrieving that uid for analysis without contaminang 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
reect the underlying pathophysiologic disease process. The locaon for sampling is dependent upon the clinical indicaons, with most op-
erators reporng decreased yield from gravity dependent lower lobes, and maximum yields from the middle lobe or lingula, even in paents
with diuse lung disease. In paents with focal disease, target regions can be idened based on careful review of high-resoluon comput-
ed tomography scans.
Various methods for determining BAL insllaon volume have also been described and adjusng the amount of inslled volume (per weight
of the subject) has been proposed at least in children. Quanes inslled may vary based on clinical seng and insllaon technique, as
well as on underlying disease or normality and insllaon protocols (2). Technique is important because studies have shown that many fac-
tors can inuence the quality and composion of BAL samples, including the volume of saline inslled and the length of dwell me between
insllaon 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, inslling more than 100cc but less than 300cc of isotonic saline soluon, and using 3-5 sequenally inslled aliquots via a
handheld syringe (although some operators insll via tubing). Fluid is retrieved by gentle sucon that can be performed using the syringe, or
by using the sucon channel of the bronchoscope (wall sucon should probably be reduced to between 60 mm and 100 mm). In both in-
stances it is oen possible to watch the stream of air bubbles as uid is aspirated (See Figure 1).
Sucon 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 intersal lung
disease and when BAL is done for research purposes or any indicaons other than presumed infecon 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 dierent from a bronchial wash. To maximize uid return, some operators me uid insllaon and aspiraon with
the paent’s respiratory eorts. 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 inslled (and ideally closer to 40 or 50 percent) as necessary
to be considered sasfactory and reliable (4).
Henri Colt MD, FAWM
Professor Emeritus, University of California, Irvine
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 insllaon aer wedging the exible bronchoscope into the distal bronchus. Bubbling is noted along with a patent air-
way during gentle sucon and uid retrieval (note absence of airway wall collapse). From Colt HG, www.Bronchoscopy.org (hps://
In conclusion, many papers describing BAL in healthy and diseased paents report a variety of dierent techniques, but follow a few general
rules such as: selecng the target region using computed tomography, gradual insllaon of a set amount of uid using several aliquots, gen-
tle sucon of uid in a way that avoids airway wall collapse, avoiding bronchial epithelial cell contaminaon of specimens, and separang
samples into site-specic sterile containers dependent on the needs and preferences of the instuon’s laboratory and depending on tests
requested (cytology, proteomics, cell counts and dierenals, 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 instuons, procedures
should be standardized as best possible, and performed in a uniform manner by bronchoscopy teams within an instuon aer consultaon
with laboratory personnel, dependent of course on logiscs, medical experse, needs, and indicaons for the procedure. It goes without say-
ing that paents 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 multude of review papers, book chapters, and scienc studies for
informaon about indicaons, contraindicaons, precauons in select populaons, ethics of performing the procedure especially in the re-
search seng or in healthy subjects, complicaons, specimen handling, uid processing and analysis, and other step-by-step descripons/
guidelines/summaries of BAL procedural techniques.
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 Arcle, 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 dierent actors of the humanitarian world: The Internaonal Commiee of Red
The InRed Cross (ICRC), was established in 1863. Its mission is to work worldwide to ensure hu-
manitarian protecon and assistance for people aected by conict and armed violence. Their acvies are launched in re-
sponse to emergencies and with the main commitment of assuring the respect for internaonal humanitarian law. It is an
independent and neutral organizaon, whose mandate is based on the Geneva Convenons of 1949.
The group that was going to become the Internaonal Commiee 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 Bale of Solferino had taken place on 24 June 1859 resulng in the victory of the Napolean French Army and Sardinian
Army against the Austrian Army. The bale was a parcularly brush 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, congur-
ing a parcular horrifying war scenario. Jean-Henri Dunant, who (being there for a business trip) witnessed the aermath of
the bale in person, was movated by the horric suering of wounded soldiers le on the baleeld and started social and
polical advocacy against the cruelty in war, a campaign that would eventually result in the Geneva Convenons and the
establishment of the Internaonal Red Cross. Dunant could witness the thousand wounded, dying and dead remained on the
baleeld, and the absence of any aempt to provide care. He was shocked, and organized the civilian populaon, especial-
ly the women and girls, to provide assistance to the injured and sick soldiers. Most importantly, he convinced the populaon
to service the wounded without regard to their side in the conict under the moo "Tu fratelli" (All are brothers). His ideas
were the basis of the 1864 Geneva Convenon. In 1901 he received the rst Nobel Peace Prize together with Frédéric Passy.
Dunant and his colleagues got to meet government representaves to agree on Dunant's proposal for naonal relief socie-
es, to help military medical services to provide medical care. Aerwards, they convinced governments to adopt the rst
Geneva Convenon, 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 unied neutral medical services.
Currently, the work of the ICRC is based on the Geneva Convenons of 1949, their Addional Protocols, its Statutes and
those of the Internaonal Red Cross and Red Crescent Movement and the resoluons of the Internaonal Conferences of
the Red Cross and Red Crescent. The ICRC is an independent, neutral organizaon ensuring humanitarian protecon and
assistance for vicms of armed conict and other situaons of violence.
The ICRC's primary role was a coordinang one. But it gradually became more involved in eld operaons, as the need for a
neutral intermediary between belligerents showed to be increasingly important .
The acon of the ICRC is based on 7 fundamental principles: Humanity, imparality, neutrality, independence, voluntary ser-
vice, unity and universality. Those principles provide the ethical, operaonal and instuonal 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 acvies 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 organizaon because it is funded by voluntary contribuons from the States party to the Geneva
Convenons (governments); naonal Red Cross and Red Crescent sociees; supranaonal organizaons (such as the Europe-
an Commission); and public and private sources. That is a dierent structure and prole that the one of the internaonal
humanitarian NGOs. A non-governmental organizaon (NGO), or "civil society organizaon" is a not-for-prot group, princi-
pally independent from government, which is organized on a local, naonal or internaonal level to address issues in sup-
port of the humanitarian aid. There are usually task-oriented (health, educaon, human rights, housing, etc.) and made up of
people with a common interest. The NGOs give direct services and humanitarian funcons, but also have a strong task of
advocacy (depending on each organizaon) bringing public concerns to governments, monitoring policy and program imple-
mentaon, and engaging the civil society in the direct acon.
This dierenaon is essenal and clearly established by the Sphere Project: NGOs (Non-Governmental Organizaons) refers
to organizaons, both naonal and internaonal, which are constuted separately from the government of the country in
which they are founded. That is dierent from the NGHAs: (Non-Governmental Humanitarian Agencies) that include the
components of the Internaonal Red Cross and Red Crescent Movement - The Internaonal Commiee of the Red Cross,
The Internaonal Federaon of Red Cross and Red Crescent Sociees and its member Naonal Sociees - and the NGOs as
dened above. A dierent category are the IGOs (Inter-Governmental Organizaons) name that refers to organizaons con-
stuted by two or more governments. It thus includes all United Naons Agencies and regional organizaons.
This dierences between NGOs an mul-government agencies are reected in the dierent mandates they work on. The
legal mandates of internaonal agencies working in humanitarian operaons are of two main types: state-mandated or self-
mandated. United Naons organizaons, like UNHCR, UNICEF, UN WFP, UN WHO and UN OCHA, have internaonal man-
dates that are legally recognized by states. So too do the Internaonal Commiee of the Red Cross (ICRC), the Internaonal
Federaon of Red Cross and Red Crescent Sociees, Naonal Red Cross/Crescent Sociees and the Internaonal Organiza-
on for Migraon (IOM). These agencies can be described as state-mandated. All other agencies largely NGOs and CBOs -
tend to be self-mandated as voluntary organizaons set up as private iniaves seeking public support. Self-mandated agen-
cies are usually registered, recognized and regulated by states to diering degrees but do not carry a formal internaonal
mandate. This rst sense of the term mandate reects an idea of internaonal legimacy grounded in the power of either
states or civil society.
As clearly marked by Steven Ratner, “The ICRC thus represents a sui generis enty in the internaonal legal process. Its sta-
tus under Swiss law as a private associaon 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-
gaons resemble the workings of an internaonal organizaon. Its close es to Switzerland its locaon, the naonality of
Commiee members and senior sta, and frequent contacts with the Swiss Foreign Ministry18 give it a prole unique
among internaonal organizaons and NGOs; and the ICRC clearly benets from Switzerland’s reputaon of neutrality in
internaonal aairs. Governments and armed groups suspicious of the moves of NGOs based in the United Kingdom, the
United States, or France will be less likely to aack the moves of the ICRC”.
Even when their relaon with the dierent governments and their source of funds give each one of those categories very
dierent proles and responsibilies in front of their funders, all of them share the Code of Conduct that must rule the acv-
ies of any humanitarian organisaon. 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 oer it, is a fundamental humanitarian
principle which should be enjoyed by all cizens of all countries. As members of the internaonal 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 obligaon to provide humanitarian assistance wherever it is needed which requires unimpeded
access to aected populaons as a fundamental component of that responsibility. The prime movaon is to alleviate hu-
man suering and no polical movaon should be included in their choices.
The humanitarian imperave (according to UNICEF) means that “human suering must be addressed wherever it is found,
with parcular aenon to the most vulnerable in the populaon. The dignity and rights of all those in need of humanitarian
assistance must be respected and protected”. The humanitarian imperave implies a right to receive humanitarian assis-
tance and a right to oer it. At mes, humanitarian access to civilian populaons is denied by authories for polical or secu-
rity reasons. Humanitarian agencies must maintain their ability to obtain and sustain access to all vulnerable populaons and
to negoate such access with all pares to the conict.
In spite of some apparently clear mandates and denions, humanitarian acon is currently challenged by many evolving
and changing pracce in warfare. New geo-polical tensions and some more classical problems of neutrality, protracon and
relief ethics make humanitarian policy and pracce more and more dicult in the current mes. Managing these tensions
requires constant and prudenal judgement by the dierent humanitarian actors. But the humanitarian aid all over the
world requires the connuous support of the civil sociees and the understanding of their responsibility in monitoring the
respect of internaonal law by their States, a responsibility that civilian and ordinary cizens cannot delegate.
*The views expressed in this arcle are those of the author and do not necessarily reect the ocial posions of the Execu-
ve Board or Internaonal 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 invesgave tool used by Respiratory Physicians in almost all centres in UK providing Respiratory Med-
icine services, an approximate esmate 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 paent is given sedaon with
Midazolam on an average between 2-3 milligrams, very occasionally paents with low or borderline saturaons would be done without seda-
on. Lignocaine Nasal or Oral spray is oen 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 paents 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 Aspiraon (TBNA) biopsies the number of Bronchoscopies
have been reduced, but almost one in four Respiratory set up around UK are using Linear EBUS for diagnoscs in Lung cancer diagnosis by biop-
sying the Mediasnal Lymph Nodes. So the approach is usually Hit and Run for diagnosc reasons but some would also do complete staging as
well as diagnoscs for Lung cancer and other cancers causing Mediasnal 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 starng EBUS procedures.
Rapid on site Examinaon and slide evaluaon (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 Navigaonal Bronchoscopy for biopsy-
ing peripheral lung lesions
Both convenonal 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 starng Bronchoscopy or EBUS in real paents. 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-
Education and Training
P A G E 10
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 aendees from over 40 countries, abstract presenters, faculty and keynote pre-
senters, sponsors and more. We would like to express our hearelt gratude to Dr. Eric Edell and sta for organizing a very suc-
cessful congress with the most in-depth scienc program for a WCBIP event to date.
(Le to right: Dr. Edell with his opening remarks; Nave Pride Dancers celebrang and blessing our gathering of guests at opening
ceremony; Prof. Udaya Prakash presenng)
WABIP Awards - These awards recognize our members who have made a signicant impact on the art and science of bronchol-
ogy, whether as a result of lifelong career achievements or subming an innovang 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 Invesgator Awards for Research and Clinical Innovaon: Dr. Liyan Bo, Dr. Alex Chee, and Dr. Yu
(Le to right: –WABIP Chair Dr. Zsolt Papai and Awards commiee chair Dr. Pedro Grynblat presenng to Dr. Gasparini, Dr. Diaz-
Jimenez, Dr. Bo, Dr. Chee, Dr. Chen)
P A G E 11
New Execuve 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 Execuve Board, who are:
Chair: Silvia Quadrelli, M.D. (Argenna)
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” funconing and operaons of the associaon, the WABIP Execuve Board will connue to move
forward with our organizaon's mission and goals in advancing paent care, research, and educaon in bronchology, intervenon-
al pulmonology and related areas.
P A G E 12
The Holy Grail of Pleurodesis
“Out Paent Pleurodesis”
The pursuit of outpaent pleurodesis has long been the focus of Intervenonal Pulmonologists.
As physicians taking care of paents with advanced malignancies and Malignant Pleural Eusions (MPE), we are well aware of the ominous
prognosis of a majority of these paents with few excepons such as breast cancer. In malignancies such as lung cancers, several studies (1)
show a dismal prognosis of less than a few months aer the discovery of MPE. In scenarios like these, the goal of therapy is more focused on
palliaon rather than cure and quality of life takes precedence over longevity with suering. Paents with such malignancies usually have al-
ready spent an inordinate amount of me in and around the hospitals for the diagnosc workup, extensive mul-modality treatments including
chemotherapy, surgery, and radiaon therapy. Quite oen they have also had recurrences, metastasis, and other complicaons adding to their
hospital visits and stays. MPE is and should be considered just another manifestaon of the above menoned, i.e., recurrence, metastasis, or
complicaon. The tradional approach of managing MPE has been repeated thoracentesis or a chest tube placement with or without chemical
pleurodesis in an inpaent seng. A large number of these paents are poor candidates for surgical intervenons such as mechanical pleu-
rodesis or decorcaons 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 menon the exponenally high cost of hospitalizaon compared to home and hospice.
As a consequence, Intervenonal Pulmonologists have been on the lookout for ways to manage MPE and other chronic, recurrent, and sympto-
mac pleural eusions in an outpaent seng. In the last approximately 15 years, the invenon of Indwelling Pleural Catheters (IPC) from Den-
ver, Colorado USA has proven to be a signicant step forward in that direcon. Now there are several iteraons of these catheters available
around the world. IPC can be placed in the procedure rooms or the clinics without adming paents to the hospital and can be drained by the
paents themselves, their family members or health care workers. Once there is no more uid drained for three consecuve drainages, which
usually happens in approximately 47% of the paents in approximately 54 days (2), these catheters can be removed in the outpaent oces or
clinics. However, as menoned earlier, about 50 % of the paents may connue to drain for several months and beyond or require an inpaent
chemical pleurodesis via the exisng catheters or more invasive procedures to achieve pleurodesis. Even in paents 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 menoned ear-
lier. Naturally, the next goal of physicians has been to achieve outpaent pleurodesis in more paents and much shorter period using IPCs.
There are several studies underway to achieve just that. These studies include drug-elung indwelling catheters, inslling sclerosing agents thru
the indwelling catheters or placing IPC following a relavely minimally invasive procedure called medical pleuroscopy and Talc poudarage.
Editorial Staff
Associate editor: Dr. Ali Musani
Associate editor: Dr. Sepmiu Murgu
Editor-in-Chief: Dr. Kazuhiro Yasufuku
Primary Business Address:
Kazuhiro Yasufuku, Editor-in-Chief
WABIP Newsleer
c/o Judy McConnell
101 College St., TMDT 2-405
Toronto, Ontario M5G 1L7
Phone: 416-581-7486
E-mail: newsleer@wabip.com
P A G E 13
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 paents from 18 centers in the UK were randomized into two groups. One group received 4 grams of Talc thru the IPC as outpaents while
the other group received placebo. The paents 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 signicant excess of blockages of the indwelling pleural catheter was noted in the talc group. No sig-
nicant dierences in adverse events were idened either.
Although this study shows a signicantly 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 outpaent chemical pleurodesis. More studies of dierent
agents delivered in various fashions such as drug-elung IPCs and installaon of various chemicals via IPCs will eventually bring us closer to our
target of achieving minimally invasive, rapid, and outpaent pleurodesis with the goal of enabling paents to spend more me in the comfort of
their homes surrounded by their families and friends.
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
Internaonal Conference on Intervenonal Pulmonology and Hands-on Training Program - IP2018
Organized by – Bangladesh Associaon for Bronchology and Intervenonal Pulmonology (BABIP)
Endorsed by - World Associaon for Bronchology and Intervenonal Pulmonology (WABIP)
The 1
internaonal conference on Intervenonal Pulmonology organized by BABIP is a landmark in the history of Intervenonal Pulmonology
of Bangladesh. Since its birth on 2015, BABIP had arranged scienc conferences each year. But this is the rst me when BABIP could arrange
a successful and truly internaonal program. Geng 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 Crical Care Medicine, University of California, USA
who guided, gave valuable advices and unfeered
supports and lastly wrote an enchanng message for
souvenir that enlightened the parcipants.
The conference was held on May 13
, 2018 in
Bangabandhu Internaonal Conference Center
(BICC) and Square Hospitals Ltd., Dhaka. On 13
the conference started at 8.20 am. Professor Mirza
Mohammad Hiron, Chairman and Dr. Md. Sayedul
Islam, Secretary General of BABIP inaugurated the
scienc session. Total 289 delegates from home
and abroad parcipated in the conference. Among
them there was specialist and trainee pulmonologists,
internists, thoracic surgeons, pediatric pul-
monologists, intensivists and respiratory nurses.
Total 8 facules from Japan, UK, Thailand and India along with local facules took part in the scienc program. Especially the presence of
Professor Hideo Saka, Secretary General of WABIP increased the elegance of the program. Other facules were Dr. Jamsak Tscheikuna, Associ-
ate Professor, Respiratory Medicine, Mahidol University, Thailand; Dr. Kedar Hibare, Intervenonal Pulmonologist, Narayana Health, India and
Chair, WABIP Social Media Commiee; Dr. Sushmita Roychoudhury, Intervenonal 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, Naonal Instute of Diseases of the Chest and Hospital (NIDCH), Bangladesh and WABIP
Regent for Bangladesh; Dr. Nirmal KanSarkar, 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 Intervenonal Pulmonology among the parcipants as well as conduct an eecve hands-on workshop.
Parcipants at a glance
Professor Mirza Mohammad Hiron Dr. Md. Aminul Islam
P A G E 16
Day-1, Session-1
The scienc session started with a lecture of Dr. Nirmal Kan Sarkar on “Fiberopc Bronchoscopy- How I do it”. His discussion included de-
tails of step-by-step procedure, paent preparaon, segmental anatomy, complicaons during bronchoscopy and a video presentaon. Dr.
Fazle Rabbi Mohammed spoke on “Bronchoscopic sample collecon” which covered BAL, brush, biopsy technique and transbronchial lung
biopsy. Dr. Md. Khairul Anam focused on dierent 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 “Intervenonal Pulmonology: past, present and future” – a very colorful lecture
where he depicted the history of intervenonal 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 waing. He discussed the details of diagnosc approaches, dierent modalies, 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
TNM classicaon of lung cancer” with changes from previous 7
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 beauful 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 intervenonal 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 paents” a mind blowing discussion in-
Day-2, Session-1
This session started with another vibrant lecture by Professor Hideo Saka on “Cryoprocedures in Intervenonal Pulmonology”. His discussion cov-
ered in-depth of cryoprocedure in dierent lung lesion. Dr. Gella discussed on applicaon of heat in dierent lung pathologies in his lecture “Fire
in Intervenonal Pulmonology – APC, electrocautery and laser”. Dr. Fazle Rabbi Mohammed briey discussed on “Baloon bronchoplasty”.
Day-2, Session-2
Dr. Gopal Krishna Mallugari started this session with basics of Airway stenng” and shared his experience. Dr. Kedar gave another brilliant lec-
ture on “Next generaon of airway stents” which included convenonal as well as 3D and biodegradable stent and future aspects in this eld. Dr.
Bala Raju highlighted on applicaon of “Bronchial Thermoplasty” in asthma management. The lecture session was concluded by Dr. Sushmita Roy-
choudhury focusing on – “Year in review – Intervenonal Pulmonology”.
Hands-on Training program
On 2
day of program, a very well formaed hands-on training program was arranged at Square Hospitals Ltd. Total 62 registered parcipants
took part in the program. There were 9 staons namely Basic bronchoscopy including bronchial anatomy and sample collecon, cTBNA, Baloon
bronchoplasty, Convex probe EBUS, Radial probe EBUS, Cryo and APC, Rigid bronchoscopy and airway stenng, Percutaneous tracheostomy and
Indwelling pleural catheter. Parcipants 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 acve in learning and got ample me to do all the procedures in
each staon 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 staon, parcipants at workshop, cryo staon, EBUS-TBNA staon
Cercates were distributed among the parcipants. The program was concluded by the Chairperson and Secretary General, BABIP thanking all
to make the program a successful one.
From le to right: Praccing on animal cadaver, IPC staon, cTBNA staon, EBUS-TBNA staon
From le to right: Workshop at a glance, radial probe EBUS staon, balloon bronchoscopy staon, rigid bronchoscopy staon
Cercate distribuon Photo session with workshop parcipants and faculty
The WABIP has started a new educaon project recently: THE WABIP ACADEMY. The WABIP Academy will pro-
vide free online webcasts with new and hot topics that will interest pulmonologists and intervenonalists.
Current webcast topic: Tissue acquision for biomarker directed therapy of NSCLC
You can reach these webcasts by using this link: hp://www.wabipacademy.com/webcast/
www.bronchology.com Home of the Journal of Bronchology
www.bronchoscopy.org Internaonal educaonal website for
bronchoscopy training with u-tube and
facebook interfaces, numerous teachiing
videos, and step by step tesng and assess
ment tools
www.aabronchology.org American Associaon for Bronchology and I
ntervenonal Pulmonology (AABIP)
www.eabip.org European Associaon for Bronchology and
Intervenonal Pulmonology
www.chestnet.org Intervenonal Chest/Diagnosc Procedures (IC/DP)
www.thoracic.org American Thoracic Society
www.ctsnet.org The leading online resource of educaonal and
scienc research informaon for cardiothoracic
www.jrs.or.jp The Japanese Respirology Society
Asociación Sudamericana de Endoscopía Respiratoria
P A G E 19
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 (didacc lectures)
Website: hps://www.wabip.com/events/371-pulmo-delta-2018
4th Annual Scienc Meeng of the Malaysian Associaon for Bronchology and Intervenonal Pulmonology
When: October 12-14, 2018
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hp://www.mabip.com
Fih Annual Percutaneous Tracheostomy and Advanced Airway Cadaver Course
When: October 22, 2018
Where: MISTC Lab, The Johns Hopkins Hospital, Balmore, MD
Program Director: Hans Lee, MD
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hps://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: hps://www.wabip.com/events/384-advanced-bronchoscopy-course-organized-egypt
P A G E 20
Amrita Bronchology & Intervenonal Pulmonology 2018
When: October 27-28, 2018
Where: Where: Amrita Instute Of Medical Sciences, Kochi, India
Program Director: Dr. Arvind Perathur & Dr. Tinku Joseph
Program Type: Educaonal seminar (postgraduate may include physicians in pracce and trainees), Hands-on workshop, Confer-
ence (didacc lectures)
Website: hp://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 (didacc lectures)
Website: hp://www.congresoneumo.com.py/
Ninth Annual Evaluaon and Management of Pleural Disease
When: January 21-22, 2019
Where: The Johns Hopkins Hospital, Balmore, MD
Program Director: David Feller-Kopman, MD, FCCP
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hps://hopkinscme.cloud-cme.com/aph.aspx?P=5&EID=14934
8th Asian Pacic Congress on Bronchology and Intervenonal Pulmonology
When: March 27-30, 2019
Where: Gold Coast Convenon and Exhibion Centre, Broadbeach QLD 4218, Australia
Program Director: David Fielding, M.D.
Program Type: Hands-on workshop, Conference (didacc lectures)
Website: hp://www.apcb2019.com
P A G E 21