Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites

Summary

A bronchoscopy is a medical procedure that allows doctors to look directly at the airways in the lungs using a thin, flexible tube called a bronchoscope. In this procedure, biopsies can be taken from single or multiple sites within the bronchial or endobronchial areas. When necessary, fluoroscopic guidance is used to enhance accuracy.

Purpose

Medical Conditions Addressed:

• Investigate lung problems such as infections, lung growths, or blockages.
• Diagnose conditions like lung cancer, tuberculosis, or interstitial lung disease.

Goals:

• Obtain tissue samples for biopsy to diagnose lung-related issues.
• Remove foreign objects or clear blockages in the airways.
• Examine areas that previously showed abnormalities in imaging tests.

Indications

• Persistent cough, unexplained wheezing, or coughing up blood.
• Abnormalities observed in chest X-rays or CT scans.
• Suspicion of infections, tumors, or inflammatory lung diseases.

Preparation

• Patients may need to fast for 6-12 hours before the procedure.
• Inform the doctor of any medications being taken; some may need to be adjusted.
• A pre-procedure assessment including blood tests, lung function tests, and imaging.

Procedure Description

1. Sedation and Positioning: The patient is usually given local anesthetic and mild sedation or, in some cases, general anesthesia.
2. Insertion: The bronchoscope is inserted through the nose or mouth and passed down the throat into the airways.
3. Examination: Using the bronchoscope's camera, the doctor examines the bronchi.
4. Biopsy: Tissue samples are collected using special instruments passed through the bronchoscope.
5. Fluoroscopic Guidance: If needed, X-ray guidance is used to help navigate and obtain precise biopsies.
6. Completion: The bronchoscope is carefully removed.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Performed in a hospital's endoscopy suite or an outpatient clinic with specialized facilities.

Personnel

• Pulmonologist or Thoracic Surgeon
• Anesthesiologist or Nurse Anesthetist
• Registered Nurses and Medical Technicians

Risks and Complications

Common Risks:

• Sore throat or mild coughing post-procedure
• Temporary hoarseness

Rare Risks:

• Bleeding from biopsy sites
• Infection
• Pneumothorax (collapsed lung)
• Adverse reactions to anesthesia

Benefits

• Accurate diagnosis of lung conditions.
• Enables targeted treatment plans.
• Relief of airway obstruction.
• Results are often available within a few days to a week.

Recovery

• Observation for a few hours post-procedure for any adverse effects.
• Avoid eating or drinking until the numbness wears off (usually a few hours).
• Mild soreness or cough may persist for a few days.
• Follow-up appointment to discuss biopsy results and next steps.

Alternatives

• Chest CT or MRI: Non-invasive imaging but less detailed compared to direct visualization.
• Sputum Cytology: Less invasive but not as comprehensive.
• Needle Biopsy: Minimally invasive, useful for peripheral lung lesions.

Pros and Cons of Alternatives:

• Less invasive procedures have a lower risk but might not be as diagnostic as bronchoscopy.
• Imaging techniques provide preliminary information but may necessitate further invasive diagnostics.

Patient Experience

During the procedure, patients may experience pressure or mild discomfort but rarely pain due to sedation or anesthesia. Post-procedure, patients may have a sore throat, mild hoarseness, and slight coughing. Pain is typically minimal and managed with over-the-counter medications. Comfort measures include ice chips and throat lozenges.