Cryotherapy and cryobiopsy – methods that use extreme cold to freeze tissue for removal or laboratory studies – are well-established in the treatment of adult patients with certain pulmonary issues. Now, in a new analysis, researchers and clinicians at Children’s Hospital of Philadelphia (CHOP) have partnered with colleagues across the United States and shown how the field has grown dramatically in recent years to include pediatric patients and describe the effectiveness of these methods. The findings were recently published in the journal Annals of the American Thoracic Society.
Interventional pulmonology, which offers minimally invasive procedures to conduct biopsies and treatment in the airways for conditions like lung cancer, lung nodules central airway disorders and other breathing issues, has been available to adults for decades, and cryotherapy and cryobiopsy have been utilized as part of that overall strategy. CHOP launched the first pediatric Advanced Diagnostic and Interventional Bronchoscopy program in the country in 2014, with cryotherapy and cryobiopsy being part of that suite of interventions.
There has been an increased desire to use cryotherapy and cryobiopsy in children with certain pulmonary issues, such as airway blood clots or mucus plugs, since these often result in less pain and lower complication rates than other available diagnostic and therapeutic procedures. In the past, these tools were often not small enough to be used for children. However, recent advances in the field and the availability of smaller tools have increased utilization of these methods and substantially increased the understanding of their impact on pediatric patients.
“This field is small but growing,” said senior study author Joseph Piccione, DO, MS, Co-Director of the Pulmonary Advanced Diagnostic and Interventional Bronchoscopy Center, and Pulmonary Co-Director for the Center for Pediatric Airway Disorders and Esophageal and Airway Treatment Program at CHOP. “We partnered with the other centers we knew were furthest along in their understanding of this field and now have data that shows how these methods can benefit children.”
In a multicenter, retrospective observational study conducted across five pediatric hospitals in the United States, researchers analyzed results from 317 cryotherapy and cryobiopsy procedures performed in 187 patients between January 2017 and January 2025. The most common procedure utilizing these techniques was cryoextraction (50% of cases), followed by cryorecanalization (38%) and cryobiopsy (17%). The 1.1-mm cryoprobe, which was introduced around 2020, was utilized in 57% of cases and was suitable for use even in infants and small children.
The study found that cryoextraction was at least partially successful in 95% of procedures, which included removal of blood clots, mucus plugs and foreign bodies inhaled into the airways. Cryorecanalization – reopening airways narrowed by scar tissue or tumors – was at least partially successful in 93% of procedures. Cryobiopsy contributed to the diagnostic evaluation and influenced treatment strategies in 96% of biopsies with 73% overall diagnostic yield. While bleeding was the most common complication of cryotherapy, occurring in 35% of cases, 96% of cases were low-grade bleeding events involving a small amount of blood loss that did not require further intervention, and the remaining cases required minimal intervention to stop the brief bleeding (typically <1 to 5 minutes) associated with these procedures.
“These findings demonstrate a growing maturity in the field, represent one of the first multicenter pediatric interventional pulmonology studies and illuminate where this field is going,” Piccione said. “We already have other multicenter studies underway that expand upon these findings, which is great progress for this relatively new field of medicine that has existed for only a little over a decade. New tools, like the 1.1-mm cryoprobe, have enabled us to develop pediatric adaptations for diagnostic and therapeutic approaches that have been well established in the care of adult patients, and we expect more opportunities for expansion in the coming years.”
Katz et al, “Indications, techniques, and safety of cryotherapy and cryobiopsy via flexible bronchoscopy in pediatric patients” Ann Am Thorac Soc. Online April 20, 2026. DOI: 10.1093/annalsats/aaoag065.
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Cryotherapy and cryobiopsy – methods that use extreme cold to freeze tissue for removal or laboratory studies – are well-established in the treatment of adult patients with certain pulmonary issues. Now, in a new analysis, researchers and clinicians at Children’s Hospital of Philadelphia (CHOP) have partnered with colleagues across the United States and shown how the field has grown dramatically in recent years to include pediatric patients and describe the effectiveness of these methods. The findings were recently published in the journal Annals of the American Thoracic Society.
Interventional pulmonology, which offers minimally invasive procedures to conduct biopsies and treatment in the airways for conditions like lung cancer, lung nodules central airway disorders and other breathing issues, has been available to adults for decades, and cryotherapy and cryobiopsy have been utilized as part of that overall strategy. CHOP launched the first pediatric Advanced Diagnostic and Interventional Bronchoscopy program in the country in 2014, with cryotherapy and cryobiopsy being part of that suite of interventions.
There has been an increased desire to use cryotherapy and cryobiopsy in children with certain pulmonary issues, such as airway blood clots or mucus plugs, since these often result in less pain and lower complication rates than other available diagnostic and therapeutic procedures. In the past, these tools were often not small enough to be used for children. However, recent advances in the field and the availability of smaller tools have increased utilization of these methods and substantially increased the understanding of their impact on pediatric patients.
“This field is small but growing,” said senior study author Joseph Piccione, DO, MS, Co-Director of the Pulmonary Advanced Diagnostic and Interventional Bronchoscopy Center, and Pulmonary Co-Director for the Center for Pediatric Airway Disorders and Esophageal and Airway Treatment Program at CHOP. “We partnered with the other centers we knew were furthest along in their understanding of this field and now have data that shows how these methods can benefit children.”
In a multicenter, retrospective observational study conducted across five pediatric hospitals in the United States, researchers analyzed results from 317 cryotherapy and cryobiopsy procedures performed in 187 patients between January 2017 and January 2025. The most common procedure utilizing these techniques was cryoextraction (50% of cases), followed by cryorecanalization (38%) and cryobiopsy (17%). The 1.1-mm cryoprobe, which was introduced around 2020, was utilized in 57% of cases and was suitable for use even in infants and small children.
The study found that cryoextraction was at least partially successful in 95% of procedures, which included removal of blood clots, mucus plugs and foreign bodies inhaled into the airways. Cryorecanalization – reopening airways narrowed by scar tissue or tumors – was at least partially successful in 93% of procedures. Cryobiopsy contributed to the diagnostic evaluation and influenced treatment strategies in 96% of biopsies with 73% overall diagnostic yield. While bleeding was the most common complication of cryotherapy, occurring in 35% of cases, 96% of cases were low-grade bleeding events involving a small amount of blood loss that did not require further intervention, and the remaining cases required minimal intervention to stop the brief bleeding (typically <1 to 5 minutes) associated with these procedures.
“These findings demonstrate a growing maturity in the field, represent one of the first multicenter pediatric interventional pulmonology studies and illuminate where this field is going,” Piccione said. “We already have other multicenter studies underway that expand upon these findings, which is great progress for this relatively new field of medicine that has existed for only a little over a decade. New tools, like the 1.1-mm cryoprobe, have enabled us to develop pediatric adaptations for diagnostic and therapeutic approaches that have been well established in the care of adult patients, and we expect more opportunities for expansion in the coming years.”
Katz et al, “Indications, techniques, and safety of cryotherapy and cryobiopsy via flexible bronchoscopy in pediatric patients” Ann Am Thorac Soc. Online April 20, 2026. DOI: 10.1093/annalsats/aaoag065.
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