31647 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe

Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, with balloon occlusion, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe.

Summary

A bronchoscopy is a medical procedure that allows doctors to view the airways and lungs using a thin, flexible tube called a bronchoscope. This advanced procedure uses fluoroscopic guidance to accurately position a balloon to occlude the airway, measure an air leak, size the airway, and insert bronchial valves into the lung's initial lobe.

Purpose

The purpose of this procedure is to manage complex airway and lung conditions, such as persistent air leaks, lung volume reduction, or bronchial obstructions. The goal is to improve lung function, reduce symptoms, and enhance the patient's quality of life.

Indications

• Persistent air leaks
• Emphysema or other forms of Chronic Obstructive Pulmonary Disease (COPD)
• Bronchial obstruction
• Lobular over-inflation causing breathing difficulties

Preparation

• Patients may need to fast for 6-8 hours before the procedure.
• Certain medications might need to be adjusted or stopped.
• Pre-procedure tests could include blood work, chest X-rays, and pulmonary function tests.
• Patients should arrange for someone to drive them home post-procedure.

Procedure Description

1. The patient is sedated or given general anesthesia.
2. A bronchoscope is inserted through the mouth or nose and guided into the lungs.
3. Fluoroscopic guidance is used for real-time imaging.
4. A balloon catheter is placed to occlude the airway and measure any air leak.
5. The airway is measured for proper sizing.
6. Bronchial valves are then inserted into the initial lobe’s airways to control airflow.
7. The bronchoscope is carefully removed.

Tools and equipment include a bronchoscope, fluoroscope, balloon catheter, and bronchial valves.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

The procedure is performed in a hospital, usually in a specialized endoscopy suite or operating room.

Personnel

• Pulmonologist or Thoracic Surgeon
• Anesthesiologist
• Nurses and specialized technicians

Risks and Complications

• Bleeding
• Infection
• Pneumothorax (collapsed lung)
• Airway perforation
• Adverse reactions to anesthesia

Complication management strategies include close monitoring and, if necessary, surgical intervention.

Benefits

• Immediate improvement in breathing
• Reduction in persistent air leaks
• Enhanced lung function
• Potential reduction in symptoms of emphysema or COPD

Benefits can often be realized shortly after the procedure.

Recovery

• Patients may need observation for a few hours post-procedure.
• Avoid strenuous activities for several days.
• Follow-up appointments are necessary to monitor progress.
• Pain or discomfort can usually be managed with prescribed medications.

Alternatives

• Non-surgical management, such as medications and pulmonary rehabilitation.
• Surgical options like lung volume reduction surgery or lung transplant.

These alternatives may have varying effectiveness and recovery times compared to bronchoscopy with bronchial valve insertion.

Patient Experience

During the procedure, patients will not feel discomfort due to sedation or anesthesia. Post-procedure, they might experience mild throat discomfort, coughing, or shortness of breath. Pain management and comfort measures are provided to ensure a relatively smooth recovery.