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A Guide to Bronchoscopy

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A Guide to Bronchoscopy

Pulmonology | by Dr. Raja Dhar | Published on 03/08/2020



Bronchoscopy is a medical procedure used to examine the airways in the lungs. This procedure involves inserting a flexible tube called a bronchoscope into the patient's mouth or nose and passing it down into the trachea (windpipe) and bronchi (the large airways in the lungs). The bronchoscope is fitted with a light and a camera, allowing doctors to view the airways in real-time on a monitor.

Bronchoscopy is used to diagnose and treat a range of lung conditions, including infections, tumors, inflammation, and bleeding. Here is a closer look at the procedure and its uses. This blog contains information about bronchoscopy and when it is recommended. However, please note that this blog does not replace the significance of a doctor’s consultation.

What Are The Different Types Of Bronchoscopy?

Doctors classify bronchoscopy into two main types - Flexible and Rigid.

  • Flexible Bronchoscopy - Flexible bronchoscopy is the most common type of bronchoscopy. It uses a thin, flexible bronchoscope that can be guided through the airways to reach areas of interest. This type of bronchoscopy can be performed under local anesthesia, meaning the patient is awake but numb in the throat area. Sedation is also sometimes used to help the patient relax.
  • Rigid Bronchoscopy - Rigid bronchoscopy involves the use of a larger, more rigid bronchoscope. This type of bronchoscopy is typically used for more complex procedures, such as removing foreign objects from the airways or treating large tumors. Rigid bronchoscopy is usually performed under general anesthesia, meaning the patient is asleep during the procedure.

Why Is Bronchoscopy Done?

Bronchoscopy is used for both diagnostic and therapeutic purposes. Here are some of the most common uses of the procedure:

  • Diagnosing Lung Conditions - Bronchoscopy is often used to diagnose lung conditions that are difficult to detect using other methods. For example, it can be used to detect lung cancer, infections such as tuberculosis, and other lung diseases.
  • Taking Biopsy Samples -During a bronchoscopy, the doctor can take tissue samples (biopsies) from the lungs for further analysis. These samples can be used to confirm a diagnosis or determine the best course of treatment.
  • Removing Foreign Objects - Bronchoscopy can be used to remove foreign objects that have become lodged in the airways. This can include food, small toys, or other objects that may have been accidentally inhaled.
  • Treating Lung Conditions - In some cases, bronchoscopy can also be used to treat lung conditions. For example, it can be used to remove tumors or other obstructions from the airways or to treat bleeding in the lungs.

How To Prepare For Bronchoscopy?

Preparing for a bronchoscopy usually involves food and medication restrictions for a specified period. Your doctor will inform you about the necessary precautions you should take owing to your current medication use. You have to avoid foods and drinks for at least 6-12 hours before the bronchoscopy procedure. Your doctor will also advise you against certain medications like:

  • Warfarin
  • Ibuprofen
  • Aspirin
  • Clopidogrel
  • Blood thinners

You will likely be given sedative medicines via IVs or a local anesthetic spray to help you relax. Make sure to arrange a ride or someone to take you back home after the procedure. Because of the sedatives as you will be unable to drive.

How Is Bronchoscopy Performed?

Before the procedure, doctors spray a numbing drug or sedative into the mouth or throat. But if the bronchoscope is inserted through the nose, a numbing jelly is placed in the nostrils. Many people are given anesthesia to help them relax.

Once people start to relax from sedatives, doctors gently insert the bronchoscope into the bronchi. This usually makes people cough at first but subsides as the numbing drug takes effect. As doctors move the bronchoscope around, you can feel a tugging or pressing sensation.

The next part of the procedure is called a lavage or bronchial washing. Doctors send a saline solution through the tube to wash the lungs. Lavage is also used to collect samples of lung cells, microbes, fluids, and other substances inside the air sacs. These samples are examined later under a microscope.

Additionally, tiny brushes, needles, or forceps are sometimes passed through the bronchoscope to take small tissue samples (biopsies) from the lungs. Doctors can also insert a stent in your airways and perform an ultrasound. This helps doctors to have a clearer view of the lymph nodes and tissues around the airways.

Once the procedure finishes, doctors remove the bronchoscope. A bronchoscopy typically lasts about 30-60 minutes based on your lung condition and the number of examinations. And people can return home on the same day.

Recovery After Bronchoscopy:

Recovery from bronchoscopy is fairly fast. You have to stay at the hospital for a couple of hours and let the sedative wear off once the procedure is over. Doctors usually monitor your breathing and blood pressure during recovery time. The numbness in your throat will subside within two hours. Following this, you can safely consume any food and drink. However, your throat will be sore for a couple of days.

Are There Any Risks and Complications Of Bronchoscopy?

Bronchoscopy is usually safe for most people. Nonetheless, there are certain risks involved, although uncommon and minor. Complications may arise because of the sedative used or the procedure itself. Risks of bronchoscopy may include the following - 

  • Breathing troubles
  • Minor bleeding, if a biopsy was done
  • Fever
  • Infection
  • Pneumonia
  • Abnormal heartbeat
  • Low blood oxygen levels during the procedure

In rare cases, bronchoscopy can also cause a heart attack or lung collapse which is known as pneumothorax resulting in a life-threatening situation. The chances of pneumothorax are usually increased when doctors use a rigid bronchoscope to perform the procedure. There may be additional risks from anesthesia such as - 

  • Muscle pain
  • Nausea
  • Vomiting
  • A slow heart rate
  • Change in blood pressure

Conclusion:

Bronchoscopy is a valuable tool for diagnosing and treating a range of lung conditions. If you are scheduled to have a bronchoscopy, be sure to discuss the risks and benefits of the procedure with your doctor beforehand. With proper preparation and care, a bronchoscopy can provide important information about your lung health and help guide your treatment plan.

FAQs

 

Is bronchoscopy painful?

Bronchoscopy is not a painful test. However, you may feel a bit uncomfortable during the procedure. The doctor makes sure to not hurt you and makes you feel as comfortable as possible. 

Can bronchoscopy detect TB?

Yes, bronchoscopy is a reliable test to detect pulmonary tuberculosis. Discuss your symptoms with the doctor for an early diagnosis and effective treatment. 

What is fiberoptic bronchoscopy?

Flexible fiberoptic bronchoscopy (FFB) is a minimally invasive procedure that allows the surgeon to directly visualize the upper and lower airways using a light source, fiber optics, and a camera. 

Can a bronchoscopy detect lung cancer?

While there are still debates on the accuracy of bronchoscopy being able to detect cancer, it can detect suspicion of cancer in several chronic smokers. However, the procedure may miss 40% to 50% of lung cancers. 

How long does a bronchoscopy biopsy take?

On average, bronchoscopy usually takes about 30 minutes. However, it can vary depending on the severity of the condition, the medical health of the individual, and the extent of the test. 

Can you drink water before bronchoscopy?

No, a bronchoscopy exam requires an empty stomach which means you cannot eat or drink 6-8 hours before the procedure. Talk to your doctor about how you can prepare for the procedure to avoid any complications.