The multicentre PROTECT study demonstrates that routine prophylactic use of adrenaline or ice-cold saline does not significantly reduce iatrogenic bleeding in unselected patients undergoing endobronchial biopsy.
Subgroup analysis suggests a potential benefit of ice-cold saline in patients younger than 65 years (RR 0.90, p=0.04), warranting further targeted investigation.
Evidence-based practice is shifting away from routine pre-procedural pathology (coagulation and platelets) for low-risk patients, favoring a targeted approach based on clinical risk factors.
Technological advancements, including robotic-assisted bronchoscopy and cryoprobe biopsies, offer superior diagnostic yields compared to conventional methods while maintaining favorable safety profiles.
