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The technique of adult flexible bronchoscopy: Part 1

The technique of adult flexible bronchoscopy: Part 1

ABSTRACT: Flexible bronchoscopy was clinically introduced by Shigeto Ikeda in 1968 and is now used widely for diagnostic and therapeutic interventions. A combination of advancing technology and ingenuity has fostered the development of an expanded array of devices and applications. The newer video bronchoscopes offer higher-resolution images than fiberoptic bronchoscopes. The advantages of fiberoptic technology are lower cost and greater technical ease of adapting to smaller-diameter bronchoscopes. Hybrid bronchoscopes have an imaging lens and fiberoptic bundles that transmit the viewing image to a charge couple device (CCD) chip in the body of the operator end of the bronchoscope. The digital image is transmitted from the CCD chip to the external processor for viewing on a monitor, for digital storage, or for printing. (J Respir Dis. 2008;29(11):423-428)

Since its introduction by Shigeto Ikeda in 1968, flexible bronchoscopy has become a valuable diagnostic and therapeutic tool for pulmonologists- to a large degree, defining the subspecialty.1 Flexible bronchoscopy can be performed on spontaneously breathing patients in either the outpatient or inpatient setting and on more seriously ill patients who are on mechanical ventilation. This versatility has led to the development of a wide variety of techniques, tools, and procedures that provide unprecedented diagnostic and treatment options.

In this introduction to the series "The technique of adult flexible bronchoscopy," we categorize the various bronchoscopic procedures and discuss the indications, complications, basic equipment, and preprocedure preparations. While advanced procedures require additional skill and training, a thorough understanding and mastery of the fundamentals of bronchoscopy is a prerequisite. We present this introductory article to provide the foundation for the in-depth discussion of the basic technique of flexible bronchoscopy and the more advanced and specialized applications, which will appear in future issues of The Journal of Respiratory Diseases.

TYPES OF PROCEDURES

Flexible bronchoscopy can be divided into routine, advanced, and specialized procedures (Table 1). Routine bronchoscopy is performed by most pulmonologists and includes inspection and sampling. Inspection involves a survey of the upper and lower airway, with attention to the appearance and function of the vocal cords, the tracheal and bronchial anatomy, and the airway mucosa.

Advanced bronchoscopic procedures, such as transbronchial biopsy, are performed by some, but not all, pulmonologists because of the greater technical complexity and slightly higher risk. Specialized procedures, which include brachyradiation and bronchoplasty, are performed by relatively few pulmonologists and may require advanced training.

Flexible bronchoscopy is also used in a few special circumstances, such as the evaluation of vocal cord dysfunction. Investigational bronchoscopic procedures should generally be performed in a clinical trial setting.

INDICATIONS

Flexible bronchoscopy can be performed for diagnostic purposes, such as the investigation of hemoptysis or a radiographic abnormality, or for therapeutic purposes, such as laser resection of a tumor or airway clearance (Table 2). As noted above, flexible bronchoscopy may also be

used under special circumstances to facilitate other procedures, such as endotracheal intubation, or for investigational or research purposes.

COMPLICATIONS

It is not uncommon for patients to experience minor discomfort, nausea, coughing, gagging, minimal bleeding (bleeding not requiring continued suctioning), mild and transient decrease in oxygen saturation, or fever. These occurrences are not generally considered complications. Minor complications are uncommon and include moderate bleeding (persistent bleeding requiring continued suctioning of blood or wedging of the bronchoscope), persistent hypoxemia, self-limited laryngospasm, vomiting, bronchospasm, epistaxis, and vasovagal syncope.

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