Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (EBUS).

Summary

Bronchoscopy is a procedure where a doctor uses a thin, flexible or rigid tube (bronchoscope) equipped with a camera to look at the airways and lungs. Fluoroscopic guidance involves using X-rays to guide the bronchoscope during the procedure. Endobronchial ultrasound (EBUS) is an imaging technique used during the procedure to locate and sample lesions in the lungs.

Purpose

This procedure is used to diagnose and sometimes treat conditions affecting the lungs and airways. It is particularly beneficial for accessing and sampling peripheral lung lesions, which are areas of abnormal tissue.

Indications

• Persistent cough or unexplained breathing issues.
• Abnormal chest X-rays or CT scans showing masses or lesions.
• Suspected lung cancer or infection.
• Assessment and staging of lung cancer.
• Persistent lung infections not responsive to treatment.

Preparation

• Patients are usually asked to fast for 6-12 hours before the procedure.
• Adjustments in medications, particularly blood thinners, may be necessary.
• Diagnostic tests such as chest X-rays, CT scans, and pulmonary function tests might be required beforehand.
• Informing the healthcare team about allergies and current medications is crucial.

Procedure Description

1. Sedation/Anesthesia: The patient is typically given local anesthesia or light sedation; general anesthesia may be used in some cases.
2. Insertion: The bronchoscope is introduced through the nose or mouth into the lungs.
3. Fluoroscopic Guidance: Continuous X-ray imaging assists in accurately navigating the bronchoscope.
4. EBUS: EBUS technology helps visualize peripheral lesions and aids in precise sampling or biopsy.
5. Intervention: If therapeutic actions such as removing a blockage or delivering medication are needed, they are performed at this stage.
6. Completion: After all diagnostic or therapeutic interventions, the bronchoscope is carefully withdrawn.

Duration

The procedure typically takes about 30 minutes to an hour depending on the complexity of the intervention.

Setting

Bronchoscopy is performed in a hospital or specialized outpatient clinic equipped with radiologic and endoscopic facilities.

Personnel

• Pulmonologist or Thoracic Surgeon
• Anesthesiologist or sedation nurse
• Radiology technician
• Nursing staff

Risks and Complications

• Common Risks: Sore throat, cough, minor bleeding, and discomfort at the biopsy site.
• Rare Risks: Infection, lung collapse (pneumothorax), excessive bleeding, or adverse reactions to anesthesia.
• Management: Most complications are manageable with prompt medical care and monitoring.

Benefits

• Precise diagnosis of lung conditions.
• Early detection and staging of lung cancer.
• Targeted treatment for specific lung problems.
• Minimally invasive with high diagnostic yield.

Recovery

• Patients may experience mild sore throat or cough.
• Rest and avoiding strenuous activities for 24 hours post-procedure is recommended.
• Follow-up appointment to discuss biopsy results and further management.
• Normal activities can typically resume within one to two days.

Alternatives

• CT-guided biopsy: Less invasive but may not access all lesions.
• Sputum cytology: Non-invasive but less accurate.
• Surgical biopsy: More invasive but highly accurate.
• Each alternative has its own risk-benefit profile which should be discussed with the healthcare provider.

Patient Experience

• Patients may feel pressure or discomfort during the procedure despite sedation.
• Post-procedure, they might experience mild sore throat, cough, or hoarseness.
• Pain relief measures and monitoring will be provided to ensure comfort during recovery.