Bronchoscopy is generally safe with few complications in most patients with COPD. Patients with objectively confirmed severe to very severe COPD had more frequent respiratory complications than patients without COPD. The risks were not prohibitively high, but should be taken into consideration for COPD patients undergoing moderate sedation flexible bronchoscopy.

Background: Diagnosing mediastinal and hilar lymphadenopathy and staging lung cancer with endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) are on the rise, but uncertainty surrounds the optimal number of cases needed to achieve acceptable yields. Objectives: To determine the threshold at which EBUS-TBNA reaches adequate yields among trainees and skilled bronchoscopists. Methods: We reviewed all EBUS-TBNAs performed at our medical center since implementing the use of EBUS (n = 222). Results: EBUS-TBNAs were performed in 222 patients (344 nodes). The percentage of adequate specimens sampled (diagnostic specimens or nodal tissue) rose from 66% in 2008 to 90% in 2012 (p < 0.01) and cancer yield improved from 34% in 2008 to 48% in 2012 (p < 0.01). Attending physicians who performed an average of more than 10 procedures per year had higher yields compared to those who performed fewer than 10 procedures per year (86 vs. 68%, p < 0.01). The yield of trainees also improved with every 10 procedures (79, 90 and 95%, p < 0.001) and that of attending physicians with experience (1-25 procedures: 78% yield, 26-50 procedures: 87% yield and 50+ procedures: 90% yield; p < 0.01). Among trainees, failure rates declined steadily. Conclusion: EBUS-TBNA yield (malignant and benign) increases with increasing experience amongst experienced bronchoscopists and trainees as early as the first 20-25 procedures. Pulmonary trainees had a rapid decline in failure rates. These findings suggest that in an academic environment a minimum of 20-25 procedures is needed to achieve acceptable yields.

In the absence of randomized clinical trials and evidence-based guidelines, disparities exist in the use of bronchoscopy in the management of infiltrates. These differences were observed within and between both specialties. This study reflects the need for further research to better define the role of bronchoscopy in these patients.

Background: Bronchoscopy is a safe and minimally invasive diagnostic tool, but no studies have reported prospectively on sedation and outcomes in patients with objectively defined obesity. Objectives: The purpose of the study is to determine if obese patients require more sedation or had more procedural complications during bronchoscopy under moderate sedation than non-obese patients. Methods: We evaluated complications and sedation requirements in non-obese versus obese patients, defined by multiple criteria including body mass index (BMI), neck circumference, abdominal height, and Mallampati scores. Results: Data were collected prospectively in 258 patients undergoing bronchoscopy under moderate sedation. By varying criteria, there were the following proportions of obese patients: 30% by BMI >30, 39% by neck circumference >40 cm, and 35% by abdominal height >22 cm in males and >20 cm in females. Sedative and analgesic dosing was not clinically significantly higher in obese patients than in non-obese patients. There was no difference in complications or procedural success based on obesity criteria. Hemoglobin oxygen desaturations occurred more often during bronchoscopy in patients with increasing Mallampati scores (p = 0.04), but this had no effect on bronchoscopy time or successful completion of the procedure. A subset of patients with previous polysomnogram-proven obstructive sleep apnea were more likely to have earlier termination of their procedure (15.8%) than patients with no diagnosed sleep apnea (2.3%; p = 0.002). Conclusion: In this prospective assessment of patients with obesity, we found neither clinically significant differences in sedation needs nor increases in complications in obese versus non-obese patients using a variety of indices of obesity.

Aims: Pulmonary leiomyomas are rare benign tumors that may cause symptoms when they spread endobronchially. Traditionally they were managed surgically or through interventional bronchoscopy with the aid of thermal modalities to assist in debulking of tumor. We report the novel use of microdebrider bronchoscopy to debulk an endobronchial leiomyoma in a symptomatic patient. Method/Results: The microdebrider successfully débrided the endobronchial leiomyoma. Conclusion: This modality can be successfully employed when oxygenation is an issue, preventing use of thermal modalities. In addition, use of microdebrider not only reduced procedure time but also decreased the risk of airway fire and damage to adjacent normal tissue in our patient.Please cite this paper as: Wahla AS, Khan I, Bellinger C, Haponik E and Conforti JF. Use of microdebrider bronchoscopy for the treatment of endobronchial leiomyoma. Clin Respir J 2011; 5: e4-e7.

Diagnosis of peripherally located lung masses is of low yield with flexible bronchoscopy and carries a high risk of pneumothorax with transthoracic fine needle aspiration. Electromagnetic navigation bronchoscopy has been used in these situations with reported high diagnostic yield and low risk of complications. We carried out a review of literature to assess the diagnostic yield and complication rate of electromagnetic navigation bronchoscopy compared with the traditionally used modalities for the diagnosis of peripheral lung lesions. (Clin Pulm Med 2011;18:42-45) T he increasing use of computed tomography (CT) scan has resulted in the finding of more than 150,000 solitary pulmonary nodules in the United States per year. 1 These are often followed by yearly CT scans, exposing the patient to the risks associated with radiation. 2 Moreover, the prognosis of lung cancer depends on the timely diagnosis and the stage of the disease. Bronchoscopy is the diagnostic tool of choice for central lesions, that is, masses located in the more proximal airways. The bronchoscopic yield for neoplasms located in the outer third of the lung is less than 30%. 3-5 Peripherally located nodules that are less than 2 cm in diameter have an even lower yield using bronchoscopy (14%). 3 For peripheral nodules, the modalities used for diagnosis include surgical resection, with higher morbidity and mortality (0.5%-5.3%), 6 and transthoracic fine needle aspiration (TTFNA). The diagnostic yield of TTFNA is 64% to 97% 7-9 with a diagnostic accuracy of 94% 7 but the risk of pneumothorax ranges between 23% and 44%. 3,10-12 The risk of pneumothorax increases if there is a coexistent emphysema and increases 4-fold if the lesion is more than 2 cm away from the pleura. 13 Electromagnetic navigation bronchoscopy (ENB) has been introduced as a diagnostic tool for bronchoscopic biopsy of peripheral lung nodules, with a potential to decrease the risk of pneumothorax yet maintain the diagnostic yield observed with surgical resection or TTFNA. MYTHENB has a lower risk of complications with diagnostic yields comparable to TTFNA. DATAIn 2005, Hautmann et al 14 published data on 16 patients who were prospectively evaluated using ENB and fluoroscopy. Five patients had solitary pulmonary nodules, 8 had lung infiltrates, and 3 had lung masses. The average nodule size was 22 ± 6 mm. Three of the 5 solitary pulmonary nodules and all 3 lung masses biopsied were positive for malignancy, whereas 5 of the 8 infiltrates biopsied gave positive results consistent with granulomas, invasive aspergillosis, radiation pneumonitis, interstitial lung disease, and bronchioalveolar cell carcinoma. The procedure time compared with regular bronchoscopy was increased by 3.9 ± 1.3 minutes with the use of navigation bronchoscopy. There were no complications. The authors concluded that electromagnetic navigation was safe and useful in the diagnosis of small or fluoroscopically invisible lung lesions (Table 1, evidence grade C).Becker et al 16 published prospective data on 29 bronchos...

Uremia is associated with an increased risk of bleeding by virtue of alteration in platelet adhesion. Pulmonologists are frequently called upon to perform flexible bronchoscopy in patients with chronic renal insufficiency. The high blood urea nitrogen levels may predispose these patients to a high risk of bleeding complications with bronchoscopic procedures. We carried out a literature review to evaluate the myth that bronchoscopy is unsafe in uremic patients.

Flexible bronchoscopy is generally a safe procedure with few complications. The procedure is usually performed with sedation to maximize patient comfort. However, use of sedation may predispose the patient to cardiorespiratory complications. We carried out a literature review to evaluate the myth that sedation is required for successful completion of flexible bronchoscopy without causing undue distress to the patient and an increase in complications.