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Caution to use CO2 cryotherapy for foreign body removal in children: Authors’ reply

To the Editor: We thank Hammer et al. for their attention to and comments regarding our article about the use of CO2 cryotherapy with a flexible bronchoscope to remove foreign bodies lodged in children’s airways. While drafting the article to report results of our early work with an ultrafine flexible cryoprobe, we took care to acknowledge the established use of the rigid bronchoscope for removal of foreign bodies from the airways of infants and young children.Wewent on to cite thework of pioneers who are developing cryoscopy with flexible bronchoscopes, reported our own procedures and results, and, while noting some of the promising aspects of cryoextraction using a flexible bronchoscope, pointed out the limits of the early work in our report. The caveats raised by Hammer et al. are important, and we agree that practitioners should be aware of them, but we differ in emphasizing the importance of exploring and refining new techniques. We described the indications for our cryotherapy with the flexible bronchoscope and analyzed the characteristics of suitable cases. Careful patient evaluation with clear inclusion and exclusion criteria obviously are imperative, and we continue to find that flexible bronchoscopy under local anesthesia produces satisfactory results in appropriate patients. Progress in medical therapies is unevenly distributed, and certain medical equipment and techniques in developing countries differ from those that may or may not be available in other countries. For example, referral to a remote hospital or better-equipped medical facility may not be practicable in certain locations. Medical progress also depends on the judicious development and exploration of both current and emerging technologies. In the present study, we reported steps in the development a newer technique to remove foreign bodies in children’s airways. We cannot say at present that the new technique has supplanted rigid bronchoscopy, but neither should we abandon work on a potentially efficacious approach that may save our children’s lives.