Study of comparison of medical thoracoscopic guided biopsy versus closed pleural biopsy for etiological diagnosis of undiagnosed exudative pleural effusions: A randomized controlled study.

Background: Medical thoracoscopy (MT) has gained widespread acceptance in the diagnosis of undiagnosed exudative pleural effusions. In developing countries, including India medical thoracoscopy is not widely available.

Objective: 1. To analyze the yield of closed pleural biopsy (CPB) in comparison with MT in the diagnosis of undiagnosed exudative pleural effusions. 2. Comparison of complications between CPB and MT.

Methods: This was a prospective randomized controlled study conducted in a tertiary care centre, from January 2020 to September 2021. The patients with undiagnosed exudative pleural effusions were included in the study. The enrolled patients were randomized into two groups, group A and group B. Total of 38 patients were taken, 19 patients in each group. Group A was subjected to MT. Group B was subjected to CPB with cope's needle. Ultrasound was used to mark the site of pleural effusion.

Results: Diagnostic yield was 78.9% in both MT and CPB group. CPB was significantly less painful procedure compared to MT. The duration of hospital stay was also significantly less in CPB as compared to MT (P < 0.001). CPB was associated with 5.3% mortality and there was no mortality in MT group.

Conclusions: Our study recommends that, in the era of medical thoracoscopy, closed pleural biopsy still holds a significant role in the diagnosis of undiagnosed exudative pleural effusions especially where prevalence of tuberculosis is high. It is also a cost effective approach in developing countries like India.