Abstract
ABSTRACTObjective To describe indications, clinical outcomes and complications of flexible bronchoscopy.Methods A descriptive observational study of bronchoscopies performed at the endoscopy service of Hospital Israelita Albert Einstein . Demographic (age, gender and origin) and medical (indications and results of endoscopy and diagnostic tests, such as biopsy collection, lavage, cytology and culture) data were analyzed. Electronic medical records with incomplete data or reporting interventional procedures were excluded.Results Over a three-year period (2013 to 2016), a total of 1,949 bronchoscopies were performed by respiratory endoscopy team and anesthesia specialists of the hospital. The mean age of patients was 57.7±21.9 years (range of 3 days to 99 years), with prevalence of males (56.4%). The procedures were mostly (86.3%) elective and 30.7% were carried out in the intensive care unit. Major indications for bronchoscopy were infection or secretion (42.4%), followed by suspected neoplasm (10.8%). Endoscopic changes were reported in 91.9% of cases, with more than one change described in approximately 6.9% of patients. Positive results were obtained via direct testing or culture in 36.3% and 53.9% of 1,399 bronchoalveolar lavages, respectively. The overall diagnostic yield (bronchoalveolar lavage and biopsy) was 72.6%. Mild adverse event rate was 7.2%. The rate of severe adverse events requiring additional intervention was 0.5% (pneumothorax, 0.4%; severe bleeding with patient death, 0.1%).Conclusion Lower airway endoscopy is critical for respiratory disease assessment, diagnosis and treatment. Flexible bronchoscopy is associated with good diagnostic yield and minimal inherent risk.
Highlights
Endoscopic changes were reported in 91.9% of cases, with more than one change described in approximately 6.9% of patients
A positividade da biópsia é entre 14% a 50% para nódulos pulmonares (≤3cm) e entre 46% a 80% para massas pulmonares (>3cm).(1,2,11) Técnicas avançadas de ultrassonografia endobrônquica com probe radial (EBUS radial) têm melhorado de maneira significativa o rendimento diagnóstico das lesões pulmonares periféricas durante a broncoscopia, com rendimento diagnóstico alcançando 74% para nódulos e 92% para massas pulmonares.(12) Nosso rendimento geral das biópsias por broncoscopia nesta série foi de 49%, ou seja, está de acordo com o descrito a literatura, que prediz um resultado
Summary
Indications, clinical outcomes and complications of 1,949 flexible bronchoscopies. Altair da Silva Costa Jr.[1], Paulo Rogerio Scordamaglio[1], Iunis Suzuki[1], Addy Lidvina Mejia Palomino[1], Marcia Jacomelli[1]. Métodos: Foi realizado um estudo observacional descritivo das broncoscopias realizadas no serviço de endoscopia do Hospital Albert Einstein. Foram analisados: informações demográficas, como idade, gênero e procedência; dados clínicos sobre a indicação do exame; e resultados endoscópicos e dos exames diagnósticos realizados, como biópsias, lavados, citologias e culturas. Resultados: No período de 3 anos, de 2013 a 2016, foram realizadas 1.949 broncoscopias no hospital pela equipe da endoscopia respiratória e anestesiologista. A média de idade dos pacientes foi de 57,7±21,9 anos, (variação: 3 dias a 99 anos), com prevalência do gênero masculino (56,4%). A maioria dos exames (86,3%) foi eletiva e 30,7% foram realizados na terapia intensiva. Nas alterações endoscópicas das broncoscopias realizadas, obtivemos os dados em 91,9% dos exames. Foram realizados 1.399 lavados, com positividade de 36,3% nas pesquisas diretas e 53,9% nas culturas. A broncoscopia flexível tem bom rendimento diagnóstico e risco mínimo associado
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