Flexible through rigid bronchoscopy for airway foreign body: A good marriage of convenience!

Abstract

To the Editor, Aspiration of a foreign body is commonly reported among children. Considered the gold standard for extraction of airway foreign bodies, rigid bronchoscopy fails in up to7% 1,2 of cases. Although there are reports of successful use of flexible bronchoscope for airway foreign body removal it has many limitations. We describe an adolescent patient wherein a distally placed airway foreign body, after the failure of removal with rigid bronchoscope twice, could be removed successfully using flexible-through-rigid bronchoscopy technique. We discuss the advantages of this technique over either of the scopes used alone. A 12-year-old girl presented with 3-year history of cough and purulent expectoration, responding partially to inhaled bronchodilators. There was no seasonal or diurnal variation, wheezing, chest pain, hemoptysis, or cyanosis. There were episodes of intermittent undocumented fever episodes over the past 2 years. There was decrease in exertional capacity over the past 6 months. There was no history of change in appetite, ear or nasal symptoms, aggravating or relieving factors, vomiting, epigastric discomfort, severe multisystemic infections, or malabsorption. There was no contact with active tuberculosis. Examination revealed normal vital signs and oxygen saturation in room air. Weight, height, body mass index of 41 kg, 156 cm, and 16.85, respectively, were normal for age and

A systematic review of using flexible bronchoscopy to remove foreign bodies from paediatric patients

“…19,21,36 Singal et al described how a flexible bronchoscope was inserted through a rigid scope to remove a foreign body from the airway of a 12-year-old girl. 58 These studies underline the need for specific tools to improve how flexible bronchoscopy is used to remove foreign bodies from children.…”

“…In 29 of the 2588 cases a rigid endoscope was used to remove a foreign body out of the oropharynx after it had been extracted from the tracheobronchial tree with a flexible bronchoscope 19,21,36 . Singal et al described how a flexible bronchoscope was inserted through a rigid scope to remove a foreign body from the airway of a 12‐year‐old girl 58 …”

Pediatric Bronchoscopy for Airway Foreign Bodies in the ACS NSQIP‐P: Morbidity and Mortality 2014–2019

“…As the choice of anesthesia and mode of ventilation (spontaneous versus controlled) during bronchoscopic removal of AFBs are currently debated, the efficacy of newer sedatives such as fospropofol, remifentanil, and dexmedetomidine during bronchoscopy are being evaluated 12,13 . Additionally, new surgical techniques for removal of AFBs such as endoscope‐assisted rigid bronchoscopy, flexible bronchoscopy, flexible bronchoscopy through a rigid bronchoscope, and flexible bronchoscopy aided with a suction tube are being developed and studied 14–17 …”

“…12,13 Additionally, new surgical techniques for removal of AFBs such as endoscope-assisted rigid bronchoscopy, flexible bronchoscopy, flexible bronchoscopy through a rigid bronchoscope, and flexible bronchoscopy aided with a suction tube are being developed and studied. [14][15][16][17] Although NSQIP-P reports data in a large number of categories, this study is limited by the variables not reported in the database. It would have been useful to collect data on anesthetic techniques to determine their impact on adverse events.…”