The role of bronchoscopy in the diagnosis of airway disease

Abstract

Endoscopy of the airway is a valuable tool for the evaluation and management of airway disease. It can be used to evaluate many different bronchopulmonary diseases including airway foreign bodies, tumors, infectious and inflammatory conditions, airway stenosis, and bronchopulmonary hemorrhage. Traditionally, options for evaluation were limited to flexible and rigid bronchoscopy. Recently, more sophisticated technology has led to the development of endobronchial ultrasound (EBUS) and electromagnetic navigational bronchoscopy (ENB). These technological advances, combined with increasing provider experience have resulted in a higher diagnostic yield with endoscopic biopsies. This review will focus on the role of bronchoscopy, including EBUS, ENB, and rigid bronchoscopy in the diagnosis of bronchopulmonary diseases. In addition, it will cover the anesthetic considerations, equipment, diagnostic yield, and potential complications.

Indications, clinical outcomes and complications of 1,949 flexible bronchoscopies

“…The demographic profile of patients in this sample (prevalence of male patients aged 50 to 60 years) is consistent with literature data. ( 2 , 4 , 5 ) Age per se is not a risk factor or contraindication for bronchoscopy. ( 2 ) Most patients (30.7%) in this study were at an intensive care unit, the hospital sector where respiratory endoscopy is more often performed, with 23% of ICU patients required bronchoscopy at some point.…”

“…Most of the bronchoscopies showed endoscopic alteration, in 1,410 patients (78.7%), compatible with the consulted literature. ( 1 , 3 , 5 ) In 382 patients (21.3%), the exams were normal but it does not mean without pulmonary alterations, refers only to the endoscopic features of the bronchial tree.…”

“…( 9 ) Bronchoalveolar lavage is a sensible and specific tool for etiologic agent identification in immunocompromised patients. ( 2 , 4 , 5 ) The diagnostic yield of different methods is organism-specific. For example, BAL has 90% to 98% sensitivity for detection of Pneumocystis jirovecii in cases with no history of therapeutic or prophylactic antimicrobial therapy.…”

“…Bronchoscopy has also experienced major advances with the advent of novel technologies, such as endoscopic laser resection, deployment of endobronchial orthoses devices, brachytherapy catheters, electrocauterization techniques aimed at hemostasis or tissue resection, therapeutic and diagnostic cryotherapy, endobronchial ultrasound (EBUS) and electromagnetic scanning, among others. ( 2 , 4 , 5 )…”

Flexible bronchoscopy in pulmonary diseases in children with congenital cardiovascular abnormalities

“…Complications are associated with an individual patient's risk factors, medication used and ventilation technique. Typical complications include trauma of nose and airway, desaturation and hypoxemia, cough and bronchospasm, hemorrhage, pneumothorax and fever and infection (18). Thus, safety is a priority prior to performing FB, particularly in children.…”