New procedure of bronchoalveolar lavage using a balloon catheter in diffuse lung diseases

Abstract

Various procedures for bronchoalveolar lavage (BAL) have been developed. BAL needs a wedge between the bronchoscope and the inner surface of the bronchus. The feasibility of performing BAL at the targeted position cannot be determined until immediately before the procedure. We examined BAL performed using a balloon catheter to evaluate the stability of the procedure itself and quality of the specimen obtained. The main inclusion criteria were diffuse lung disease with a shadow in the B5a area. The tip of a disposable balloon catheter was passed through the orifice of the B5a bronchus, and the balloon was expanded at the B5a bronchus. A 50-mL syringe containing saline was instilled, and gentle hand suction was performed. This procedure was repeated two more times (total: 150mL). In all the 13 patients, the balloon of the catheter was inflated at the B5a bronchus. The median recovery rate was 34.92%±13.22%. These values were comparable to previously obtained BAL data (control group, N=56) from our facility. The BAL fluid findings and final diagnosis, with the exception of one undiagnosed case, were consistent. Overall, four patients suffered an adverse event during BAL (hypoxemia). All cases were managed by increasing the oxygen flow rate, and the adverse event did not affect the subsequent examinations. Using a balloon catheter enabled us to perform BAL at the intended bronchus. The quality of the obtained specimen was also acceptable.