31631 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required)

Name of the Procedure:

Bronchoscopy (Rigid or Flexible), including Fluoroscopic Guidance with Placement of Tracheal Stent(s) and Tracheal/Bronchial Dilation

Summary

A bronchoscopy is a medical procedure where a doctor uses a thin tube with a light and camera (a bronchoscope) to look inside the airways leading to the lungs. The procedure can be performed with either a rigid or flexible bronchoscope. It often includes fluoroscopic guidance (a type of real-time X-ray) and may involve placing a stent in the trachea to keep it open and dilate any narrowed areas.

Purpose

This procedure is primarily used to address airway blockages or narrowing (strictures) that can cause breathing difficulties. The main goals are to open up the airways, allow for better airflow, and alleviate symptoms such as shortness of breath.

Indications

• Severe or recurrent airway obstruction
• Stridor (a high-pitched wheezing sound caused by disrupted airflow)
• Tumors or growths in the trachea or bronchi
• Scarring or narrowing (stenosis) of the airways
• Tracheomalacia (weakness of the tracheal walls)

Preparation

• Patients are typically required to fast for several hours before the procedure.
• All current medications should be reviewed, and some may need to be adjusted or discontinued.
• Pre-procedure tests may include blood work, chest X-rays, and pulmonary function tests.

Procedure Description

1. Sedation/Anesthesia: The patient will receive sedation or general anesthesia to ensure comfort.
2. Bronchoscope Insertion: The bronchoscope is inserted through the mouth or nose into the trachea.
3. Fluoroscopic Guidance: Real-time X-ray images guide the procedure.
4. Airway Examination: The doctor examines the airways for blockages, abnormal growths, or other issues.
5. Dilation: If necessary, the doctor will use instruments to dilate (widen) the narrowed areas.
6. Placement of Stent: A tracheal stent is then placed in the narrowed area to keep it open.
7. Completion: The bronchoscope is carefully removed.

Duration

The entire procedure typically takes about 1 to 2 hours, but this may vary depending on complexity.

Setting

This procedure is usually performed in a hospital, specifically in an operating room or an advanced endoscopy suite.

Personnel

• Pulmonologist or Thoracic Surgeon
• Anesthesiologist
• Trained Nursing Staff
• Radiology Technician (for fluoroscopy)

Risks and Complications

• Bleeding
• Infection
• Pneumothorax (collapsed lung)
• Airway injury
• Reaction to anesthesia
• Difficulty breathing post-procedure

Benefits

• Improved airflow and breathing
• Relief from symptoms like shortness of breath and stridor
• Stabilization of the airway, preventing collapse

Recovery

• Patients generally spend a few hours in recovery for monitoring.
• Post-procedure instructions include rest, avoiding strenuous activities, and specific care for the stent.
• Follow-up appointments are necessary to check the stent and overall airway condition.
• Recovery time varies but most patients can return to normal activities within a few days.

Alternatives

• Medical management with medications (e.g., steroids, bronchodilators)
• Non-invasive airway clearance techniques
• Surgical options like tracheal resection (surgical removal of part of the trachea)

Patient Experience

During the procedure, patients will be under sedation or anesthesia, so they should not feel any discomfort. Post-procedure, they may experience mild sore throat, coughing, or discomfort at the stent site, which can be managed with medications. Rest and adherence to post-procedure instructions are essential for a smooth recovery.