{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T21:23:28Z","timestamp":1787433808373,"version":"build-2736575974"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"Abstract<\/jats:title>\n \n Rationale<\/jats:title>\n Cryotherapy and its diagnostic analogue, cryobiopsy, are emerging techniques via bronchoscopy with a wide range of clinical applications. While the use of cryotherapy and cryobiopsy has been established in adult pulmonary medicine, pediatric data describing the indications, procedural specifics, outcomes, and complications are limited.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To describe the indications, procedural specifics, outcomes, and complications of cryotherapy and cryobiopsy use in pediatric bronchoscopy.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A multicenter retrospective observational study was conducted at 5 pediatric hospitals in the United States. Patients aged 0 to 21\u2009years who underwent cryotherapy or cryobiopsy via bronchoscopy between January 2017 and January 2025 were included.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 317 cryotherapy and cryobiopsy procedures were performed in 187 patients (median age 10 [3, 15] years; 44% female). The most common indication was cryoextraction (50%), followed by cryorecanalization (38%) and cryobiopsy (17%). The 1.1-mm cryoprobe was used in 57% of cases. Cryoextraction was at least partially successful in 95% of procedures, with the most common use being removal of blood clots (57%). Cryorecanalization was at least partially successful in 93% of procedures. The use of cryobiopsy has grown the most over the past 2 years. Cryobiopsy yielded successful histopathologic evaluation in 96% of biopsy specimens with 73% diagnostic yield. Bleeding was the most common complication of cryotherapy, occurring in 35% of cases, with 96% being grade 1 or 2. No pneumothorax was observed. Other complications were rare.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Cryotherapy and cryobiopsy via bronchoscopy in pediatrics have been increasingly used, demonstrating high success and a favorable safety profile. The introduction of the 1.1-mm cryoprobe has facilitated its broader application to pediatrics. Bleeding was the most common complication but was generally mild in the context of the selected cases at specialized centers.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag065","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T07:46:30Z","timestamp":1776757590000},"page":"1190-1196","source":"Crossref","is-referenced-by-count":2,"title":["Indications, techniques, and safety of cryotherapy and cryobiopsy via flexible bronchoscopy in pediatric patients"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2244-9186","authenticated-orcid":false,"given":"Alex J","family":"Katz","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Hospital of Philadelphia , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haley","family":"Haskett","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Hospital of Philadelphia , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kubra M","family":"Bozkanat","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Cincinnati Children\u2019s Hospital Medical Center , Cincinnati, OH,","place":["United States"]},{"name":"Division of Pediatric Pulmonary, Asthma and Sleep Medicine, Stanford University School of Medicine , Palo Alto, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aoife","family":"Corcoran","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Hospital of Philadelphia , Philadelphia, PA,","place":["United States"]},{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren M C","family":"Grant","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Hospital of Philadelphia , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoinette","family":"Wannes Daou","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Hospital of Philadelphia , Philadelphia, PA,","place":["United States"]},{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sin","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Nursing and Clinical Care Services, Children\u2019s Hospital of Philadelphia , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra","family":"Caylan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology and Sleep Medicine, UT Southwestern Medical Center , Dallas, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfin","family":"Vicencio","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, Icahn School of Medicine at Mount Sinai , New York, NY,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan T","family":"Benscoter","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Cincinnati Children\u2019s Hospital Medical Center , Cincinnati, OH,","place":["United States"]},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherie A","family":"Torres-Silva","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Cincinnati Children\u2019s Hospital Medical Center , Cincinnati, OH,","place":["United States"]},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara M","family":"Zak","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Cincinnati Children\u2019s Hospital Medical Center , Cincinnati, OH,","place":["United States"]},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory","family":"Burg","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Cincinnati Children\u2019s Hospital Medical Center , Cincinnati, OH,","place":["United States"]},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa R","family":"Young","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Hospital of Philadelphia , Philadelphia, PA,","place":["United States"]},{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pelton","family":"Phinizy","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Hospital of Philadelphia , Philadelphia, PA,","place":["United States"]},{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailendra","family":"Das","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Baylor College of Medicine , Houston, TX,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard Paul","family":"Boesch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik B","family":"Hysinger","sequence":"additional","affiliation":[{"name":"Division of Pulmonary Medicine, Cincinnati Children\u2019s Hospital Medical Center , Cincinnati, OH,","place":["United States"]},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine , Cincinnati, OH,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Piccione","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Sleep Medicine, Children\u2019s Hospital of Philadelphia , Philadelphia, PA,","place":["United States"]},{"name":"Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"2026082217114126600_aaoag065-B1","doi-asserted-by":"publisher","first-page":"151065","DOI":"10.1016\/j.sempedsurg.2021.151065","article-title":"Pediatric advanced diagnostic and interventional bronchoscopy","volume":"30","author":"Piccione","year":"2021","journal-title":"Semin Pediatr Surg"},{"key":"2026082217114126600_aaoag065-B2","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1183\/09031936.02.00204602","article-title":"ERS\/ATS statement on interventional pulmonology","volume":"19","author":"Bolliger","year":"2002","journal-title":"Eur Respir J"},{"key":"2026082217114126600_aaoag065-B3","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1513\/AnnalsATS.201601-062FR","article-title":"Bronchoscopic cryotherapy. Clinical applications of the cryoprobe, cryospray, and cryoadhesion","volume":"13","author":"DiBardino","year":"2016","journal-title":"Ann Am Thorac Soc"},{"key":"2026082217114126600_aaoag065-B4","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1007\/s13312-018-1344-y","article-title":"Transbronchial lung cryobiopsy for diagnosis of pediatric interstitial lung disease","volume":"55","author":"Srikanta","year":"2018","journal-title":"Indian Pediatr"},{"key":"2026082217114126600_aaoag065-B5","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1080\/17476348.2021.1987884","article-title":"Transbronchial lung cryobiopsy in children","volume":"16","author":"Moslehi","year":"2022","journal-title":"Expert Rev Respir Med"},{"key":"2026082217114126600_aaoag065-B6","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1002\/ppul.23361","article-title":"Removal of foreign bodies in children\u2019s airways using flexible bronchoscopic CO2 cryotherapy","volume":"51","author":"Zhang","year":"2016","journal-title":"Pediatr Pulmonol"},{"key":"2026082217114126600_aaoag065-B7","doi-asserted-by":"publisher","first-page":"2527","DOI":"10.1002\/ppul.26540","article-title":"Cryoextraction via flexible bronchoscopy in children with tracheobronchial obstruction","volume":"58","author":"Truitt","year":"2023","journal-title":"Pediatr Pulmonol"},{"key":"2026082217114126600_aaoag065-B8","doi-asserted-by":"publisher","first-page":"3547","DOI":"10.1007\/s00431-021-04161-5","article-title":"Bronchoscopic interventions for plastic bronchitis in children without structural heart dis\u00adease","volume":"180","author":"Kallam","year":"2021","journal-title":"Eur J Pediatr"},{"key":"2026082217114126600_aaoag065-B9","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1111\/ped.13088","article-title":"Clinical analysis of bronchoscopic cryotherapy in 156 pediatric patients","volume":"59","author":"Ni","year":"2017","journal-title":"Pediatr Int"},{"key":"2026082217114126600_aaoag065-B10","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1002\/ped4.12113","article-title":"Effective treatment of post-intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy","volume":"3","author":"Jiao","year":"2019","journal-title":"Pediatr Investig"},{"key":"2026082217114126600_aaoag065-B11","doi-asserted-by":"publisher","first-page":"e71060","DOI":"10.1002\/ppul.71060","article-title":"A systematic review of transbronchial lung cryobiopsy for pediatric interstitial lung diseases","volume":"60","author":"Damaraju","year":"2025","journal-title":"Pediatr Pulmonol"},{"key":"2026082217114126600_aaoag065-B12","doi-asserted-by":"publisher","first-page":"e27291","DOI":"10.1002\/ppul.27291","article-title":"Transbronchial cryo-nodal biopsies in children: a case series","volume":"60","author":"Bozkanat","year":"2025","journal-title":"Pediatr Pulmonol"},{"key":"2026082217114126600_aaoag065-B13","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1089\/ped.2018.0911","article-title":"Successful use of pulmonary cryotherapy for tracheobronchial thrombus extraction and recanalization of the tracheobronchial tree during a pediatric venovenous extracorporeal membrane oxygenation run","volume":"32","author":"Engelhardt","year":"2019","journal-title":"Pediatr Allergy Immunol Pulmonol"},{"key":"2026082217114126600_aaoag065-B14","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1164\/rccm.202007-2817LE","article-title":"Flexible bronchoscopic thrombus cryoextraction in a neonate on extracorporeal membrane oxygenation","volume":"203","author":"Brewington","year":"2021","journal-title":"Am J Respir Crit Care Med"},{"key":"2026082217114126600_aaoag065-B15","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1111\/resp.14353","article-title":"Cryotherapy in the paedi\u00adatric airway: indications, success and safety","volume":"27","author":"Schramm","year":"2022","journal-title":"Respirology"},{"key":"2026082217114126600_aaoag065-B16","doi-asserted-by":"publisher","first-page":"997","DOI":"10.1016\/j.jtcvs.2009.06.023","article-title":"Endobronchial tumor debulking with a flexible cryoprobe for immediate treatment of malignant stenosis","volume":"139","author":"Schumann","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026082217114126600_aaoag065-B17","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1159\/000444089","article-title":"Safety and diagnostic yield of transbronchial lung cryobiopsy in diffuse parenchymal lung diseases: a comparative study versus video-assisted thoracoscopic lung biopsy and a systematic review of the \u00adliterature","volume":"91","author":"Ravaglia","year":"2016","journal-title":"Respiration"},{"key":"2026082217114126600_aaoag065-B18","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1513\/AnnalsATS.201610-829OC","article-title":"High complication rate after introduction of transbronchial cryobiopsy into clinical practice at an academic medical center","volume":"14","author":"DiBardino","year":"2017","journal-title":"Ann Am Thorac Soc"},{"key":"2026082217114126600_aaoag065-B19","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1159\/000526876","article-title":"Safety and feasibility of a sheath cryoprobe for bronchoscopic transbronchial biopsy: the FROSTBITE trial","volume":"101","author":"Thiboutot","year":"2022","journal-title":"Respiration"},{"key":"2026082217114126600_aaoag065-B20","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.chest.2020.01.036","article-title":"Standardized definitions of bleeding after transbronchial lung biopsy: a Delphi consensus statement from the Nashville Working Group","volume":"158","author":"Folch","year":"2020","journal-title":"Chest"},{"key":"2026082217114126600_aaoag065-B21","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1002\/ppul.26977","article-title":"Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States","volume":"59","author":"Corcoran","year":"2024","journal-title":"Pediatr Pulmonol"},{"key":"2026082217114126600_aaoag065-B22","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1097\/LBR.0000000000000203","article-title":"Safety and clinical utility of flexible bronchoscopic cryoextraction in patients with non-neoplasm tracheobronchial obstruction","volume":"22","author":"Sriratanaviriyakul","year":"2015","journal-title":"J Bronchology Interv Pulmonol"},{"key":"2026082217114126600_aaoag065-B23","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/LBR.0000000000000698","article-title":"Foreign body retrieval by using flexible cryoprobe in children","volume":"28","author":"Moslehi","year":"2021","journal-title":"J Bronchology Interv Pulmonol"},{"key":"2026082217114126600_aaoag065-B24","doi-asserted-by":"publisher","first-page":"e002617","DOI":"10.1136\/bmjresp-2024-002617","article-title":"Ultrasound-guided transbronchial cryobiopsy of mediastinal and hilar lesions: a multicenter pragmatic cohort study with real-world evidence","volume":"11","author":"Mangold","year":"2024","journal-title":"BMJ Open Respir Res"},{"key":"2026082217114126600_aaoag065-B25","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1159\/000484055","article-title":"Transbronchial cryobiopsies for the diagnosis of diffuse parenchymal lung diseases: expert statement from the Cryobiopsy Working Group on Safety and Utility and a call for standardization of the procedure","volume":"95","author":"Hetzel","year":"2018","journal-title":"Respiration"},{"key":"2026082217114126600_aaoag065-B26","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1097\/LBR.0000000000000920","article-title":"Reporting standards for diagnostic testing","volume":"30","author":"Ost","year":"2023","journal-title":"J Bronchol Interv Pulmonol"}],"container-title":["Annals of the American Thoracic Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/annalsats\/advance-article-pdf\/doi\/10.1093\/annalsats\/aaoag065\/68118800\/aaoag065.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/annalsats\/article-pdf\/23\/8\/1190\/68118800\/aaoag065.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/annalsats\/article-pdf\/23\/8\/1190\/68118800\/aaoag065.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T21:11:47Z","timestamp":1787433107000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/annalsats\/article\/23\/8\/1190\/8659592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,4,20]]},"published-print":{"date-parts":[[2026,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/annalsats\/aaoag065","relation":{},"ISSN":["2329-6933","2325-6621"],"issn-type":[{"value":"2329-6933","type":"print"},{"value":"2325-6621","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,4,20]]}}}