Bronchoscopy – indications, preparation, course, possible complications

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Bronchoscopy is an endoscopic examination that can detect many respiratory diseases, such as cancer or serious damage to the trachea. What is this study and how to interpret the results? Here is some information.

Bronchoscopy – what is it?

Bronchoscopy is an endoscopic medical examination that is used to visually assess the inside of the airways (bronchi) and lungs. It involves inserting a bronchoscope – a narrow endoscopic tube with a light and a camera at one end – through the nose or mouth and passing it through the trachea for an internal view of the respiratory system.

Bronchoscopy is performed to diagnose and treat respiratory diseases. The following types of bronchoscopy are distinguished:

1. Flexible bronchoscopy: uses a long, thin, lighted tube to view the airway. A flexible bronchoscope is used more often than a rigid bronchoscope because it usually does not require general anesthesia, is more comfortable for the person, and provides a better view of the smaller airways. It also allows the doctor to take small tissue biopsy samples,
2. Rigid bronchoscopy: it is usually performed under general anesthesia using a straight, hollow metal tube. Rigid bronchoscopy is performed when there is bleeding in the airways that can block the view of the flexible scope as well as the collection of large tissue samples for biopsy. Rigid bronchoscopy is also performed to open the airway of objects (such as a piece of food) that cannot be removed with a flexible bronchoscope.

Also check: How to help yourself with COVID-19? Respiratory hygiene is important

Bronchoscopy – indications

Bronchoscopy is performed as part of the diagnosis and treatment of respiratory diseases. Bronchoscopy is performed when:

1. airway obstruction,
2. a chronic cough that has lasted more than three months with no apparent cause
3. haemoptysis (coughing up blood),
4. constant feeling of breathlessness,
5. suspicion that a foreign body may be in the respiratory tract,
6. inflammation and infections such as tuberculosis, pneumonia, fungal and parasitic pneumonia
7. interstitial lung disease,
8. paralysis of the vocal cords,
9. signs of infection in the lungs or bronchi that cannot be diagnosed otherwise or require a special type of assessment
10. signs of rejection after lung transplant.

Bronchoscopy can also be used to biopsy abnormal tissue in the lungs or airways, to biopsy the lymph nodes in the central chest adjacent to the airway to show the presence of cancer, and to visualize lung tumors that do not extend into the bronchi using a technique known as intrabronchial ultrasound (EBUS). In this procedure, a tumor deep in the airways can be visualized by ultrasound and a biopsy performed during bronchoscopy (ultrasound guided needle biopsy).

Bronchoscopy, by providing both access and a direct view of the inside of the airways and lungs, can allow your doctor to perform all kinds of procedures, such as:

1. removing fluid or mucus from the respiratory tract,
2. removing a foreign body from the respiratory tract,
3. widening (widening) of the airways that are blocked or narrowed
4. control of bleeding in the bronchi,
5. laser therapy or radiotherapy of tumors in the respiratory system,
6. rinsing the respiratory tract.

Bronchoscopy can also be used as part of some treatments for lung cancer that is in or near the large airways. It can be used to support a procedure called brachytherapy, for example, in which radiation is delivered directly to the tumor through a bronchoscope.

Read: Coronavirus causes acute interstitial pneumonia. Conversation with a pulmonologist

Procedures performed using bronchoscopy

Sometimes, as part of a bronchoscopic examination, doctors perform additional medical procedures to collect samples for testing in a laboratory. This includes:

Bronchoalveolar lavage is a procedure that doctors can use to collect samples from smaller airways and air sacs (alveoli) that cannot be seen through a bronchoscope. After the bronchoscope is inserted into the small airways, the doctor administers saline through the instrument. The fluid is then aspirated back into the bronchoscope, bringing the cells and any bacteria with it. Examination of the material under a microscope helps diagnose infections and neoplasms. You can also put the liquid in containers containing special nutrients and leave it alone for a while to see if the bacteria are growing (culture), which is a better way to diagnose an infection.

Transbronchial lung biopsy consists in collecting a sample (pieces) of lung tissue using forceps passed through the canal in the bronchoscope. The bronchoscope is advanced into smaller and smaller airways until it reaches the area of ​​interest. A doctor may use a fluoroscope (an imaging device that uses X-rays to show the internal structures of the body on a screen) to pinpoint an area of ​​interest. Doing so can also reduce the risk of accidental perforation of the lung and causing air to leak into the pleural space (pneumothorax). Although bronchial lung biopsy increases the risk of complications during bronchoscopy, it provides additional diagnostic information and may make major surgery unnecessary.

Sometimes it does transbronchial needle aspiration. In this procedure, the needle is inserted through the bronchoscope into the bronchial wall. The needle can be pierced through the wall of the large airways with direct visualization, or through the wall of the small airways using an x-ray visualization machine. Your doctor may be able to extract cells from suspicious lymph nodes and examine them under a microscope. Endobronchial ultrasound (EBUS) can be used to perform a needle biopsy.

Read also: Pylosis, an occupational disease of miners, and more

Bronchoscopy – possible complications

Complications after bronchoscopy are rare, and if they do occur, they are minor. Complications after bronchoscopy can occur if the airways are inflamed or damaged by the disease. Complications may be related to the procedure itself or to a sedative or local anesthetic.

Complications that may occur is bleeding. Bleeding is more likely to occur if you have had a biopsy. Usually the bleeding is slight and stops without treatment.

In rare cases, bronchoscopy can damage the airways. If the lung is punctured, air can collect in the space around the lung, which can cause the lung to collapse. You may also develop a fever after bronchoscopy.

See: Children who smoke passively have a lower cough reflex

Bronchoscopy – how to prepare?

Preparing for bronchoscopy usually involves restrictions on eating and taking certain medications, and discussing extra precautions with your doctor.

Before having bronchoscopy, you may be asked to stop taking blood thinners such as aspirin, clopidogrel, and warfarin (several hours or days before surgery). Before bronchoscopy, you should not eat any food or drink (at least six hours before) – you should even be on an empty stomach before the procedure. The first meal should be eaten approximately two hours after the procedure.

Bronchoscopy – what does the procedure look like?

Bronchoscopy is usually performed in a treatment room or hospital operating room. The entire procedure, including preparation and recovery time, usually takes around four hours. The bronchoscopy itself usually takes 30 to 60 minutes.

Before bronchoscopy, it is necessary to establish an access to the vein, the so-called cannula. The patient is given intravenous sedatives and (if necessary) hypnotics, as well as antitussive and analgesic drugs. The throat and nasal passages are anesthetized with lidocaine solution. The test is performed lying down.

Doctors recommend general anesthesia only on the rare occasions when they will be using a rigid bronchoscope. Once the anesthesia is working, the doctor will usually insert a flexible bronchoscope tube through the nose and throat into the bronchial tubes. As the tube enters the lungs, a person may feel a pressure or a jerk.

Some patients cough or choke initially. The doctor may administer oxygen throughout the procedure to aid breathing. The light and camera of the bronchoscope help the doctor see the airways clearly.

The doctor sometimes sprays saline through the airways, a process called bronchial lavage, to collect cells and fluids. The doctor will examine them later under a microscope.

During bronchoscopy, your doctor may perform an ultrasound to get a clearer picture of the lymph nodes and tissues in and around the bronchi.

After the airway check is complete, your doctor will remove the bronchoscope. The procedure usually takes 30-60 minutes, although the time may vary depending on the number of tests and the problem. Most people can go home on the day of surgery.

During bronchoscopy, blood saturation is also measured using a pulse oximeter. It is a device that is also available in a version suitable for use at home, for people who want to control their health. You can order a pulse oximeter through Medonet Market now.

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Bronchoscopy – convalescence at home

You should not eat or drink anything for 2 hours after bronchoscopy. Rest when you feel tired. Getting enough sleep will help you regain your strength.

Avoid strenuous activities such as cycling, jogging, weightlifting, or aerobic exercise until your doctor determines you’re okay.

After bronchoscopy, you can eat a normal diet. If you have an upset stomach, try bland, low-fat foods like plain rice, roast chicken and yogurt. If swallowing is painful, start with cold drinks or flavored ice cream.

Then try soft foods such as pudding, yogurt, canned fruit, or scrambled eggs and mashed potatoes. Avoid eating hard or coarse foods like French fries or raw vegetables. Avoid orange or tomato juice and other acidic foods that can irritate your throat.

Drink plenty of fluids to avoid dehydration (unless your doctor tells you not to). Take your pain medications exactly as prescribed. If your doctor has prescribed prescription painkillers, take them as directed. The drug should be taken after meals (unless your doctor tells you not to).

If your doctor has prescribed antibiotics, take them as prescribed. Don’t stop taking them just because you feel better. You must take a full course of antibiotics.

Bronchoscopy – results

After the bronchoscopy of the lungs is performed, the results are obtained. They are descriptive and therefore easy to read and interpret. The test is usually performed when the results of an x-ray of the lungs show certain abnormalities, or there has been a diagnosis of infiltrates in the patient’s lungs.