The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on cryotherapy for malignant endobronchial obstruction.


Lung cancer is often at an advanced stage by the time it is diagnosed and survival rates are low. Patients can develop endobronchial lesions that obstruct the major airways, causing symptoms such as dyspnoea, cough, haemoptysis and postobstructive pneumonia. The obstruction may lead to gradual asphyxiation.

The aim of treatment in patients with malignant endobronchial obstruction is mainly palliative. Current treatment options include a variety of endobronchial therapies such as resection, brachytherapy, laser ablation, photodynamic therapy and stenting. External beam radiotherapy and chemotherapy may also be used for palliative treatment.

Cryosurgery uses extreme cold to destroy tissue. General anaesthesia is usually used and a cryoprobe is inserted through a bronchoscope to reach the tumour. The selection of probe diameter depends on the size and position of the tumour. After a period of freezing, the tumour is allowed to thaw until the probe separates from the tissue. The freeze/thaw cycle may be repeated two to three times in the same place. The probe is then moved to an adjacent area and the process repeated until the whole tumour has been treated. Any resulting necrotic tumour material is then removed with forceps or the cryoprobe. Further necrotic-appearing material may be coughed out 24 to 48 hours later. The procedure can be repeated if necessary.

Coding recommendations

The code selection depends on whether a rigid bronchoscope is utilised (E50.3) or not (E48.3):

E48.3 Fibreoptic endoscopic destruction of lesion of lower respiratory tract NEC 

Y13.2 Cryotherapy to lesion of organ NOC

Chapter ‘Z’ code to indicate site treated


E50.3 Endoscopic destruction of lesion of lower respiratory tract using rigid bronchoscope NEC

Y13.2 Cryotherapy to lesion of organ NOC

Chapter ‘Z’ code to indicate site treated

In addition an ICD-10 code from category C34.- Malignant neoplasm of bronchus and lung is assigned.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.