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Pleural biopsy and talc pleurodesis in undiagnosed recurrent pleural effusions: Many trades which one to choose?

Ioannis Karampinis, Georgia Hardavella, Premjithlal Bhaskaran, Christova Ralitsa, Antonios Katsipoulakis, Gerasimos Papavasileiou, Nikolaos Anastasiou
European Respiratory Journal 2016 48: PA2525; DOI: 10.1183/13993003.congress-2016.PA2525
Ioannis Karampinis
1Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
2Department of Cardiothoracic Surgery, King's College Hospital, NHS Foundation Trust, London, United Kingdom
4Department of Thoracic Surgery, Athens Oncology Hospital, Agioi Anargiroi, Athens, Greece
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Georgia Hardavella
3Department of Respiratory Medicine, King's College Hospital, NHS Foundation Trust, London, United Kingdom
4Department of Thoracic Surgery, Athens Oncology Hospital, Agioi Anargiroi, Athens, Greece
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Premjithlal Bhaskaran
1Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
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Christova Ralitsa
1Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
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Antonios Katsipoulakis
4Department of Thoracic Surgery, Athens Oncology Hospital, Agioi Anargiroi, Athens, Greece
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Gerasimos Papavasileiou
4Department of Thoracic Surgery, Athens Oncology Hospital, Agioi Anargiroi, Athens, Greece
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Nikolaos Anastasiou
1Department of Thoracic Surgery, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
4Department of Thoracic Surgery, Athens Oncology Hospital, Agioi Anargiroi, Athens, Greece
5Department of Thoracic Surgery, Athens Metropolitan Hospital, Athens, Greece
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Abstract

Introduction: Undiagnosed recurrent pleural effusions have always been an area of diagnostic burden & have posed hurdles in patient management.

Aim: To compare three different approaches in the diagnosis & management of undiagnosed recurrent pleural effusions;VATS with double lumen and general anaesthetic (GA) vs VATS with LMA (laryngeal mask) vs medical thoracoscopy(MT)with conscious sedation.

Materials/Methods: Retrospective review of cases performed in 3 big teaching hospitals between 2004-2014. Collection of epidemiological and clinical data re:diagnostic accuracy,length of stay,recurrence, symptoms.

Results: 90 patients with initially undiagnosed recurrent pleural effusions were identified through patient records; 53 males, 37 females, mean age 58 years(+/-24 years). All were referred for pleural biopsy & talc pleurodesis; 30 had VATS biopsy with double lumen tube under GA(A), 30 had VATS with LMA(B) & 30 had MT with conscious sedation (C). Diagnostic accuracy was similar in all groups respectively: 95%, 95%% & 93%. Mean hospital stay was respectively 3.3 days, 2.2 days, 1.5 days. Recurrence was observed in ∼4% of all cases. Mean score for chest pain 24h post procedure was 6/10 for group A, 4/10 for group B and 1/10 for group C while for dyspnoea were 7/10, 5/10, 2.5/10.

Conclusions: MT with conscious sedation seems to be a better tolerated & equally efficient in pleural biopsies & talc pleurodesis in undiagnosed recurrent pleural effusions in comparison with VATS (GA/LMA). VATS with LMA has less hospital stay & better resolution of symptoms post procedure as opposed to VATS with GA. Further randomised controlled trials are required to confirm the above findings.

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Pleural biopsy and talc pleurodesis in undiagnosed recurrent pleural effusions: Many trades which one to choose?
Ioannis Karampinis, Georgia Hardavella, Premjithlal Bhaskaran, Christova Ralitsa, Antonios Katsipoulakis, Gerasimos Papavasileiou, Nikolaos Anastasiou
European Respiratory Journal Sep 2016, 48 (suppl 60) PA2525; DOI: 10.1183/13993003.congress-2016.PA2525

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Pleural biopsy and talc pleurodesis in undiagnosed recurrent pleural effusions: Many trades which one to choose?
Ioannis Karampinis, Georgia Hardavella, Premjithlal Bhaskaran, Christova Ralitsa, Antonios Katsipoulakis, Gerasimos Papavasileiou, Nikolaos Anastasiou
European Respiratory Journal Sep 2016, 48 (suppl 60) PA2525; DOI: 10.1183/13993003.congress-2016.PA2525
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