ERS statement: interventional bronchoscopy in children

Abstract

Paediatric airway endoscopy is accepted as a diagnostic and therapeutic procedure, with an expanding number of indications and applications in children. The aim of this European Respiratory Society task force was to produce a statement on interventional bronchoscopy in children, describing the evidence available at present and current clinical practice, and identifying areas deserving further investigation. The multidisciplinary task force panel performed a systematic review of the literature, focusing on whole lung lavage, transbronchial and endobronchial biopsy, transbronchial needle aspiration with endobronchial ultrasound, foreign body extraction, balloon dilation and occlusion, laser-assisted procedures, usage of airway stents, microdebriders, cryotherapy, endoscopic intubation, application of drugs and other liquids, and caregiver perspectives. There is a scarcity of published evidence in this field, and in many cases the task force had to resort to the collective clinical experience of the committee to develop this statement. The highlighted gaps in knowledge underline the need for further research and serve as a call to paediatric bronchoscopists to work together in multicentre collaborations, for the benefit of children with airway disorders.

Bronchoscopy in severe childhood asthma: Irresponsible or irreplaceable?

“…Indeed, numerous citations exist demonstrating the utility of bronchoscopy in identifying, and in some cases treating dynamic and fixed airway abnormalities, airway tumors, vascular compression anomalies, foreign bodies, and even leeches in patients mistakenly diagnosed with asthma, thus popularizing the phrase “All that wheezes is not asthma.” Nevertheless, bronchoscopy for true asthma has never fully regained its pre‐1970 status as an important component in asthma diagnosis and management. Bronchoscopy does not have a role in the current consensus statements regarding asthma management, and asthma is not an application put forth by either of the two most recent consensus statements addressing pediatric flexible bronchoscopy …”

“…Bronchoscopy does not have a role in the current consensus statements regarding asthma management, 11,12 and asthma is not an application put forth by either of the two most recent consensus statements addressing pediatric flexible bronchoscopy. 13,14 3 | KEEPING UP WITH THE TIMES: BRONCHOSCOPY AS A RESEARCH TOOL While many pre-1970 clinicians highlighted the use of bronchoscopy in the direct clinical management of patients with asthma, some also made note of pathologic findings that would ultimately prove critical to the modern understanding of asthma, commenting on the airway eosinophilia, mucus composition, and bronchial epithelium changes.…”

Interventional radiology in the airway in children

“…Diagnostic bronchography has been almost completely superseded by bronchoscopy, and by recent developments in computed tomography and magnetic resonance imaging, but is still useful as the basis of various image‐guided procedures, including balloon dilatation, stenting, and the treatment of airway fistulas . Many of these operations were pioneered by interventional radiologists (IRs), but pediatric surgeons and pulmonologists use the same or similar techniques . This article reviews the technical aspects of these procedures, with emphasis on the anesthetic implications.…”

Interventional bronchoscopy in children: Planning the path ahead

“…Burks et al also highlights difficulties training pediatric pulmonologists to perform EBUS procedures given the limited number of appropriate cases in children. The concerns raised by Burks et al regarding indications and safety for EBUS and adequate training have also been raised in guidelines published by the American Thoracic Society and European Respiratory Society . However, to answer the question posed by the title of the editorial “ Should endoscopic ultrasound‐guided biopsies for mediastinal abnormalities be performed by pediatric pulmonologists?…”

“…showing good diagnostic yield and no adverse events. 3 5 However, to answer the question posed by the title of the editorial "Should endoscopic ultrasound-guided biopsies for mediastinal abnormalities be performed by pediatric pulmonologists?" we feel that a broader view of the field of interventional bronchoscopy needs to be taken.…”