Flexible Fiberoptic Bronchoscopy is the insertion of a flexible tube or scope into the windpipe (trachea) for direct observation, and sometimes biopsy, of the airways and lungs.
Major Indications
Major Contraindications
Flexible Bronchoscope
The typical bronchoscope is a long, flexible fiberoptic tube about one-quarter inch in diameter. It has its own source of light and can be made to bend in any direction by manipulation of the controls at its near end. The scope also has a separate channel within it for vacuum suction (to remove mucous) and to insert the biopsy forceps (a long wire with pinchers on the end).
Procedure
In general, the test is performed either by a specialist in diseases of the lung (pulmonary) or by a chest (thoracic) surgeon. It is usually done at the hospital, but the patient does not have to be admitted. Prior to the procedure the patient is given an intravenous injection of a tranquilizing medicine (e.g. Versed and Demerol) which may prevent the patient from remembering the details of the test. Also the back of the throat is sprayed with a numbing local anesthetic to prevent gagging. General anesthesia is usually not required. The electrocardiogram is monitored and oxygen is administered.
The bronchoscopist inserts the scope through either the nose or mouth. There may be some coughing. As the scope is advanced down through the windpipe, the larynx (voicebox) and vocal cords can be examined. The bronchial tubes are then viewed in a systematic fashion looking for tumors, inflammation, narrowing or other abnormalities. If a biopsy is required, it is not painful. That is because there are no pain nerve fibers in the lungs. A small forceps is inserted through a channel in the scope and under direct vision the biopsy is obtained. Samples can also be obtained by fine needles or brushings, or washing the airway. Sometimes a biopsy is obtained from a very peripheral part of the lung while the lungs are simultaneously viewed on an X-ray fluoroscope screen. This procedure is called a transbronchial biopsy. At the conclusion of the procedure, the scope is removed simply by pulling it out gently. The specimens are submitted to the microbiology and pathology labs for analysis. The whole procedure takes only 15 to 20 minutes. Afterward the patient feels groggy from the tranquilizer, but is otherwise fine.
Complications
In experienced hands, bronchoscopy is a safe test; however, complications can occur. They include reactions to the anesthetic, bleeding from the nose or biopsy site, collapsed lung, wheezing, shortness of breath, fever, pneumonia, injury to the larynx and abnormal heart rhythms. The overall incidence of major complications is 0.08 percent for a regular bronchoscopy, but can increase to 2.0 percent if a transbronchial lung biopsy is performed.
Alternatives
If a particular lung disease is not able to be approached by bronchoscopy, other options may be considered
