Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, with revision of tracheal or bronchial stent inserted at a previous session (includes tracheal/bronchial dilation as required).

Summary

Bronchoscopy is a procedure where a doctor uses a thin tube (bronchoscope) to look inside the airways of the lungs. This specific type of bronchoscopy involves using X-ray guidance (fluoroscopy) to revise a stent previously placed in the trachea or bronchi, which may include widening the airways if needed.

Purpose

This procedure is designed to address problems associated with a previously inserted tracheal or bronchial stent, such as blockages, misplacements, or deteriorations. The goal is to ensure the stent is correctly positioned and functioning properly to maintain open airways, improving breathing and reducing symptoms like coughing and shortness of breath.

Indications

• Difficulty breathing or persistent coughing due to stent issues.
• Abnormal imaging results showing stent displacement or blockage.
• Symptoms of tracheal or bronchial stenosis (narrowing), such as wheezing or chest discomfort.
• Requirement for ongoing airway maintenance in patients with tracheal or bronchial stents.

Preparation

• Patients may need to fast for several hours before the procedure.
• Instructions to adjust certain medications, such as blood thinners, may be given.
• Pre-procedure assessments usually include blood tests, imaging studies, and possibly a pulmonary function test.

Procedure Description

1. The patient is given sedation or general anesthesia.
2. A flexible or rigid bronchoscope is inserted through the mouth or nose into the trachea and bronchi.
3. Fluoroscopic guidance is used to precisely locate the stent.
4. If necessary, the doctor may dilate (widen) the airways using specialized tools.
5. The stent is then revised as needed, whether repositioned, replaced, or adjusted.
6. Continuous monitoring is done throughout the procedure.
7. Once completed, the bronchoscope is carefully removed.

Duration

The procedure typically takes about 30 to 90 minutes, depending on the complexity.

Setting

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

Personnel

• Pulmonologist or thoracic surgeon
• Anesthesiologist
• Nurses and other supporting medical staff

Risks and Complications

• Bleeding
• Infection
• Injury to the airways
• Reaction to anesthesia
• Pneumothorax (collapsed lung)
• Rare: severe airway damage requiring further surgical intervention

Benefits

• Improved breathing and relief of symptoms caused by stent-related issues.
• Enhanced airway management and stent longevity.
• Better overall lung function and quality of life.

Recovery

• Post-procedure monitoring in a recovery area until sedation effects wear off.
• Patients may experience mild throat discomfort or hoarseness.
• Recovery time varies; many patients can resume normal activities within a day or two.
• Follow-up visits for further assessment may be required.

Alternatives

• Medication to manage symptoms (may not address the underlying issue).
• Laser or cryotherapy to remove obstructions without a stent revision.
• Surgical removal and replacement of the stent (major procedure with longer recovery).

Patient Experience

During the procedure, patients are typically sedated or under general anesthesia, meaning they should feel little to no discomfort. Afterward, there may be mild soreness in the throat and a feeling of tiredness. Pain management will be provided as needed to ensure comfort.