Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations.

Summary

A bronchoscopy is a procedure that allows doctors to look at your lungs and air passages using a thin tube called a bronchoscope. This specific procedure uses an ultrasound along with the bronchoscope to guide needle sampling from the lymph nodes around the lungs. It is often used to gather samples from multiple areas for analysis.

Purpose

This procedure is performed to diagnose or determine the stage of conditions such as lung cancer, infections, or other diseases affecting the lungs and lymph nodes. It helps in identifying the disease, understanding its spread, and planning the treatment further.

Indications

The procedure may be indicated for persistent cough, abnormal imaging findings, suspected lung cancer, unexplained infections, or other abnormalities in the lungs and lymph nodes. Patients showing symptoms like unexplained weight loss, coughing up blood, or persistent infections may be candidates.

Preparation

• Patients are generally instructed to fast for at least 6-12 hours before the procedure.
• Certain medications may need to be adjusted or stopped before the procedure.
• Pre-procedure tests such as blood tests, imaging studies (e.g., CT scan), and pulmonary function tests may be required.

Procedure Description

1. The patient is given local anesthesia and sedation, or general anesthesia, to ensure comfort.
2. A bronchoscope, a thin, flexible tube with a camera, is inserted through the mouth or nose into the airways.
3. Fluoroscopic guidance may be used to better navigate the bronchoscope through the airways.
4. Endobronchial ultrasound (EBUS) is then used to visualize the lymph nodes and guide the needle for sampling.
5. Samples (tissue or fluid) are taken from 3 or more mediastinal and/or hilar lymph node stations.
6. The bronchoscope is carefully withdrawn.

Duration

The procedure typically takes about 30-90 minutes, depending on the complexity and number of samples taken.

Setting

This procedure is usually performed in a hospital, surgical center, or an outpatient clinic equipped with specialized equipment.

Personnel

The procedure is performed by a pulmonologist or thoracic surgeon, with the assistance of nurses, an anesthesiologist or sedation nurse, and an ultrasound technician.

Risks and Complications

• Common risks include sore throat, coughing, and mild bleeding.
• Rare risks include significant bleeding, infection, pneumothorax (collapsed lung), or adverse reactions to sedation or anesthesia.
• Complications are managed based on severity, typically with medications or additional interventions.

Benefits

• Provides a detailed diagnosis of lung conditions and stages of diseases.
• Helps in planning targeted treatments.
• Minimally invasive compared to surgical biopsy methods.
• Results are typically available within days, enabling quicker treatment decisions.

Recovery

• Patients may be monitored for a few hours post-procedure for any immediate complications.
• Light activities are generally recommended for the rest of the day.
• Most patients can resume normal activities within 24-48 hours.
• Follow-up appointments may be scheduled to discuss results and next steps.

Alternatives

• Needle biopsy through the skin (trans-thoracic needle aspiration).
• Surgical biopsy might be considered for more extensive sampling.
• Pros of bronchoscopy include being less invasive and having quicker recovery times compared to surgical options. Cons might include limited access to certain areas that a surgical biopsy could reach.

Patient Experience

Patients might feel drowsy and have a sore throat or cough post-procedure. Any pain and discomfort are managed with appropriate medications. Patients commonly report feeling back to normal within a couple of days.