Bronchoscopy
Bronchoscopy is a test performed to view and diagnose lung disease, or problems in the bronchial tubes. It is performed using a bronchoscope, a device used to view the interior of the lungs. The doctor inserts the long tube of the bronchoscope through the patient's nose or mouth, into the trachea and then into the lungs. Bronchoscopy is usually recommended for a patient showing signs of lung disease.
Reasons for Bronchoscopy
Bronchoscopy is performed when an abnormality is observed on an X-ray or other diagnostic imaging test. It may also be performed on a patient who has, or has experienced, the following:
- Unexplained lung growth, lymph node changes or atelectasis
- Suspected interstitial lung disease
- Hemoptysis
- Obstruction of a bronchial tube
- Unexplained cough for more than 3 months
- Prolonged or puzzling infections in the respiratory tract
- Lung rejection after transplant
A person who has inhaled a known toxin may also be scheduled for bronchoscopy.
Goals of Bronchoscopy
Bronchoscopy, which can be used for both diagnosis and treatment, has applications that include the following:
- Remove fluid or mucus from the airways
- Remove a foreign object from the airways
- Dilate an airway that is blocked or narrowed
- Drain an abscess
- Treat cancer by radiating a tumor directly
- Stop bleeding in the airways
- Cleanse an airway (therapeutic lavage)
Inserting a stent to open constricted air passages can also be done via bronchoscopy.
Types of Bronchoscopy
When bronchoscopy is performed for diagnostic purposes, biopsies to determine the presence of lung or lymph node cancers can be taken. Therapeutic uses include the removal of a foreign object from the airways, dilation of an airway that is blocked or narrowed, draining of an abscess, and placement of a stent to keep an airway open.
Electromagnetic Navigational Bronchoscopy
Electromagnetic navigational bronchoscopy (ENB) is a form of diagnostic bronchoscopy. It is used to detect and help treat peripheral lung lesions, and can detect lung disease even before symptoms are present, improving the patient's prognosis. The procedure is performed under anesthesia; CT imaging is used to create a 3-D picture of the lungs. The bronchoscope is inserted through the patient's mouth and into the airways of the lungs, and catheters are placed into the bronchoscope's channel. Biopsy tools are then used to collect tissue samples for diagnosis and testing. Because ENB is minimally invasive, it reduces the potential for the complications that are more likely to result from an invasive surgical procedure.
Unlike traditional bronchoscopy, ENB can reach lesions deep within the lungs, and it is an effective alternative to needle biopsy. The procedure usually takes 30 minutes to complete.
Endoscopic Bronchial Ultrasound
Endoscopic bronchial ultrasound (EBUS) is a technique that combines ultrasound and bronchoscope technology to diagnose and evaluate the stages of lung and bronchial cancers. Performed while the patient is under sedation, EBUS involves the insertion, through the patient's mouth and trachea, of a flexible endoscope with a small ultrasound tool attached. This provides the doctor with a detailed view of the lungs in order to diagnose lung disease and determine its severity. The entire procedure takes about 30 minutes to complete, and a patient can usually return home the next day.
Bronchial Thermoplasty
Bronchial thermoplasty (BT) is a therapeutic form of bronchoscopy used primarily to treat severe cases of asthma. Using a catheter inside a flexible bronchoscope, controlled amounts of thermal energy are delivered through the patient's nose or mouth and into the lungs, helping minimize airway constriction. The patient is monitored closely following the procedure, and can usually return home the next day. BT typically requires multiple treatment sessions, which are generally scheduled 3 weeks apart.
Risks of Bronchoscopy
Although bronchoscopy is relatively safe, it does have possible risks, including the following:
- Excessive bleeding
- Pneumothorax (collapsed lung)
- Infection
- Spasms in the airway
- Cardiac complications
- Breathing difficulty
An adverse reaction to the anesthesia used is also a possibility.
Recovery from Bronchoscopy
After bronchoscopy, a follow-up visit is scheduled for the patient to discuss the results of the procedure with the doctor. If a biopsy was taken, it will take a few days for the lab results to become available. Recovery from bronchoscopy is usually short and uneventful, although the patient may experience a sore throat or hoarseness for a day or two.