Bronchoscopy

What is Bronchoscopy?
Bronchoscopy is a common semi invasive procedure  that involves the visualization of the lower respiratory tract. Respiratory secretions, bronchial and lung tissue can be obtained for microbiological and histopathological analysis. It can also be used for interventional procedures like foreign body removal, bronchial stenting, bronchial thermoplasty and bronchoscopic lung volume reduction surgery. The instrument used in bronchoscopy is called as bronchoscope. Bronchoscope consists of a fibreoptic tube with a camera and light source at the tip of the instrument. The bronchoscope is introduced through the mouth or nose, passing through the pharynx, vocal cords into the trachea and the branching airways.

Who are qualified to do bronchoscopy?
Bronchoscopy is primarily done by pulmonologists, who are specialist in respiratory medicine, thoracic surgeons and intensivists (critical care specialists).

What are the indications of bronchoscopy?
Brochoscopy is helpful in several situations. The following are some of the common indications of bronchoscopy

  1. To establish the microbial cause of lung infections
  2. To take biopsy from endobronchial lesions, lung tissue which are suspected to be malignant
  3. To establish the source of bleeding in case of hemoptysis
  4. To open up a lobe collapsed due to proximal blockage with mucus or other material
  5. Remove foreign body
  6. For all endobronchial interventional procedures
  7. For evaluating the mediastinal lymphadenopathy by nodal aspiration

How long does it take?
Depending on the procedure the time may vary. But a simple bronchoscopy with no interventions would take less than 30 minutes.

Is anesthetic medication administered during the procedure?
Local anesthetic medication is routinely used to numb the vocal cords and the airways to prevent cough while the bronchoscope is entered. Besides that a mild short acting sedative may be used in some patients who are anxious about the procedure. For majority of the patients bronchoscopy can be done with local anesthetic medications without any discomfort.

Is there any pre-procedure instructions to follow?
Consult with your bronchoscopist regarding the pre-procedure instruction. Generally you may be asked to fast without food and water for 4 to 6 hours before the procedure. This is to prevent the aspiration of food material from the food pipe (esophagus) to the lung. In case of biopsies if bleeding is expected, the doctor may advice to withhold certain medications.

What are the common complications?
Bronchoscopy is a relatively safe procedure in patients who are comfortable breathing room air. The risk of complications increases in people with prior chronic lung diseases like asthma/copd and those who need supplemental oxygen. The local anesthetic may in rare case can cause complications like arrhythmia. Some of the complication are
1) Bleeding from the biopsied site
2) Respiratory distress
3) Low grade fever post procedure
4) Nasal bleed
5) Mild hoarseness of speech
6) Pneumothorax if lung biopsy is done
7) May trigger an asthma or copd exacerbation
8) Rarely the patient may go in for respiratory failure.

Most of the complications are minor and resolve on its own. The complications are rare when bronchoscopy is done by an experienced bronchoscopist in a well equipped setting.