Flexible bronchoscopy with multiple modalities for foreign body removal in adults.

Yueh-Fu Fang,Yao-Kuang Huang,Fu-Tsai Chung,Horng-Chyuan Lin,Meng-Heng Hsieh,Shu-Min Lin,Guan-Yuan Chen,Han-Pin Kuo,Chin-Hwa Wang,Jeffrey A Gold

doi:10.1371/journal.pone.0118993

Yueh-Fu Fang, Yao-Kuang Huang + Show 8 more

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https://doi.org/10.1371/journal.pone.0118993

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Abstract

ObjectivesAspiration of the lower airways due to foreign body is rare in adults. This study aimed to determine the outcome of patients who received flexible bronchoscopy with different modalities for foreign body removal in the lower airways.Patients and MethodsBetween January 2003 and January 2014, 94 patients diagnosed with foreign body in the lower airways underwent flexible bronchoscopy with different modalities, which included forceps, loop, basket, knife, electromagnet, and cryotherapy. The clinical presentation, foreign body location and characteristics, and applications of flexible bronchoscopy were analyzed.ResultsForty (43%) patients had acute aspiration, which developed within one week of foreign body entry and 54 (57%) had chronic aspiration. The most common foreign bodies were teeth or bone. More patients with chronic aspiration than those with acute aspiration were referred from the out-patient clinic (48% vs. 28%), but more patients with acute aspiration were referred from the emergency room (35% vs. 6%) and intensive care unit (18% vs. 2%). Flexible bronchoscopy with different modalities was used to remove the foreign bodies (85/94, 90%). Electromagnet or cryotherapy was used in nine patients to eliminate the surrounding granulation tissue before foreign body removal. In the nine patients with failed flexible bronchoscopy, eight underwent rigid bronchoscopy instead and one had right lower lung lobectomy for lung abscess.ConclusionsFlexible bronchoscopy with multiple modalities is effective for diagnosing and removing foreign bodies in the lower respiratory airways in adults, with a high success rate (90%) and no difference between acute and chronic aspirations.

Highlights

Foreign body aspiration into the lower airway is less likely in adults than in children.[1,2,3,4,5,6,7,8] Some adult patients have acute aspiration within one week but often have no acute symptoms that occur in children or infants
More patients with chronic aspiration than those with acute aspiration were referred from the out-patient clinic (48% vs. 28%), but more patients with acute aspiration were referred from the emergency room (35% vs. 6%) and intensive care unit (18% vs. 2%)
Electromagnet or cryotherapy was used in nine patients to eliminate the surrounding granulation tissue before foreign body removal

Summary

Introduction

Foreign body aspiration into the lower airway is less likely in adults than in children.[1,2,3,4,5,6,7,8] Some adult patients have acute aspiration within one week but often have no acute symptoms that occur in children or infants. Foreign bodies may be embedded in granulation tissue and difficult to remove.[2, 9]. Flexible or rigid bronchoscopy is the method used to diagnose and remove foreign bodies. Granulation tissue may grow and cover the foreign body in patients with chronic aspiration. The foreign body may be hard to remove if only suction, forceps, loops, or baskets are used. In therapeutic bronchoscopy or cryobiopsy, electromagnet or cryotherapy is applied.[10,11,12,13,14] These methods can be performed in flexible bronchoscopy for patients with foreign body and granulation tissue. The electromagnet or cryotherapy can cut or destroy the granulation tissue before the forceps, loops or baskets are used to remove the foreign body

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