Diagnostic & Therapeutic Bronchoscopy

Bronchoscopy is a diagnostic procedure that allows us to look at your airway through a thin viewing instrument called a bronchoscope. During a bronchoscopy, we will examine your throat, larynx, trachea and lower airways.

Bronchoscopy may be done to diagnose problems with the airway, the lungs, or with the lymph nodes in the chest, or to treat problems such as an object or growth in the airway.

There are two types of bronchoscopy

• Flexible bronchoscopy uses a long, thin, lighted tube to look at your airway. The flexible bronchoscope is used more often than the rigid bronchoscope because it usually does not require general anesthesia, is more comfortable for the person, and offers a better view of the smaller airways. It also allows if needed to remove small samples of tissue (biopsy).
• Rigid bronchoscopy is usually done with general anesthesia and uses a straight, hollow metal tube. It is used:

– When there is bleeding in the airway that could block the flexible scope’s view.

– To remove large tissue samples for biopsy.

– To clear the airway of objects (such as a piece of food) that cannot be removed using a flexible bronchoscope.

Special procedures, such as widening (dilating) the airway or destroying a growth using a laser, are usually done with a rigid bronchoscope.

Why It Is Done

Bronchoscopy may be used to:

• Find the cause of airway problems, such as bleeding, trouble breathing, or a long-term (chronic) cough.
• Take tissue samples when other tests, such as a chest X-ray or CT scan, show problems with the lung or with lymph nodes in the chest.
• Diagnose lung diseases by collecting tissue or mucus (sputum) samples for examination.
• Diagnose and determine the extent of lung cancer.
• Remove objects blocking the airway.
• Check and treat growths in the airway.
• Control bleeding.
• Treat areas of the airway that have narrowed and are causing problems.
• Treat cancer of the airway using radioactive materials (brachytherapy).

How It Is Done

You may be asked to remove dentures, eyeglasses or contact lenses, hearing aids, wigs, makeup, and jewelry before the bronchoscopy procedure. You will empty your bladder before the procedure.

Your heart rate, blood pressure, and oxygen level will be checked during the procedure.

A chest X-ray may be done before and after the bronchoscopy.

Flexible bronchoscopy

During this procedure, you will lie on your back on a table with your shoulders and neck supported by a pillow.

You will be given a sedative to help you relax. You may have an intravenous line (IV) placed in a vein. You will remain awake but sleepy during the procedure.

Before the procedure,  a local anesthetic is sprayed into your nose and mouth. This numbs your throat and reduces your gag reflex during the procedure. If the bronchoscope is to be inserted through your nose, an anesthetic ointment is placed  in your nose to numb your nasal passages.

The thin bronchoscope is then slowly and gently inserted through your mouth (or nose) and advances it to the vocal cords. Then more anesthetic is sprayed through the bronchoscope to numb the vocal cords. You may be asked to take a deep breath so the scope can pass your vocal cords. It is important to avoid trying to talk while the bronchoscope is in your airway.

An video bronchoscope may be placed above you to provide a picture that helps us to see any devices, such as forceps to collect a biopsy sample, that are being moved into your lung. The bronchoscope is then moved down your larger breathing tubes (bronchi) to examine the lower airways.

If we collect sputum or tissue samples for biopsy, a tiny biopsy tool or brush will be used through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab to be studied.

Finally, small biopsy forceps may be used to remove a sample of lung tissue. This is called a transbronchial biopsy.

Rigid bronchoscopy

This procedure is usually performed under general anesthesia. You will lie on your back on a table with your shoulders and neck supported by a pillow.

You will be given a sedative to help you relax. You will have an intravenous line (IV) placed in a vein. Once you are asleep, your head will be carefully positioned with your neck extended. A tube (endotracheal) will be placed in your windpipe (trachea) and a machine will help you breathe. Then slowly and gently the bronchoscope is inserted through your mouth and into your windpipe.

If we collect sputum or tissue samples for biopsy, a tiny biopsy tool or a brush will be inserted through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab for biopsy.

Recovery after bronchoscopy

Bronchoscopy by either procedure usually takes about 30 to 60 minutes. You will be in recovery for 1 to 3 hours after the procedure.

Following the procedure:

• Do not eat or drink anything for 1 to 2 hours, until you are able to swallow without choking. After that, you may resume your normal diet, starting with sips of water.
• Spit out your saliva until you are able to swallow without choking.
• Do not drive for at least 8 hours after the procedure.
• Do not smoke for at least 24 hours.

Endobronchial Ultrasound (EBUS)

Endobronchial ultrasound (EBUS) is a relatively new procedure used in the diagnosis of lung cancer, infections, and other diseases causing enlarged lymph nodes in the chest.

Why is it used?

EBUS allows us to perform a technique known as transbronchial needle aspiration (TBNA) to obtain tissue or fluid samples from the lungs and surrounding lymph nodes without conventional surgery. The samples can be used for diagnosing and staging lung cancer, detecting infections, and identifying inflammatory diseases that affect the lungs, such as sarcoidosis or other cancers like lymphoma.

What makes EBUS different?

During the conventional diagnostic procedure, surgery known as mediastinoscopy is performed to provide access to the chest. A small incision is made in the neck just above the breastbone or next to the breastbone. Next, a thin scope, called a mediastinoscope, is inserted through the opening to provide access to the lungs and surrounding lymph nodes. Tissue or fluid is then collected via biopsy.

During an endobronchial ultrasound:

• We can perform needle aspiration on lymph nodes using a bronchoscope inserted through the mouth
• A special endoscope fitted with an ultrasound processor and a fine-gauge aspiration needle is guided through the patient’s trachea
• No incisions are necessary

Benefits of EBUS

• Provides real-time imaging of the surface of the airways, blood vessels, lungs, and lymph nodes
• The improved images allow us to easily view difficult-to-reach areas and to access more, and smaller, lymph nodes for biopsy with the aspiration needle than through conventional mediatinoscopy
• The accuracy and speed of the EBUS procedure lends itself to rapid onsite pathologic evaluation Pathologists in the operating room can process and examine biopsy samples as they are obtained and can request additional samples to be taken immediately if needed
• EBUS is performed under moderate sedation or general anesthesia
• Patients recover quickly and can generally go home the same day