SINGLE-USE FLEXIBLE BRONCHOSCOPY IN A RESOURCE CONSTRAINED SETTING: EXPERIENCE WITH THE AMBU ASCOPE3 IN THE GAMBIA, WEST AFRICA

Abstract

TOPIC: Procedures TYPE: Global Case Reports INTRODUCTION: Flexible bronchoscopy (FB) plays an important role in the management of Mycobacterium tuberculosis (TB) and other endemic respiratory diseases. Despite its importance, FB availability is limited to a few institutions in sub-Saharan Africa, primarily due lack of trained physicians, initial cost of procuring equipment, and other constraints related to processing, storage and maintenance.Recently, single use flexible bronchoscopes (SUFB) have been used in high income countries (HIC) with the advantage being that these devices circumvent some of the cost limitations of reusable flexible bronchoscopes (RFBs);and are therefore are an attractive option for many health systems. To date however, there are no publications on the use of SUFBs in sub-Saharan Africa (SSA). We present our experience with the Ambu® aScope™ 3 SUFB at a government hospital in The Gambia, West Africa. CASE PRESENTATION: We evaluated 7 patients referred for bronchoscopy evaluation at the Kanifing General Hospital- a 150-bed hospital. 6 patients were AFB sputum negative, while one could not produce a sputum sample. FB was performed in the operating room with continuous hemodynamic and respiratory monitoring. Procedural sedation was achieved with Ketamine administered by certified nurse anesthetists. Patient characteristics are summarized in Table 1. Patients were all male, median age 40 years (IQR 20 - 43) median ESR 95mm/Hr (IQR 17 - 130), HIV + 1/7 (14%), median WBC 5.22 x 10*9 (IQR- 3.48-7.17).Bronchoscopy was successful in all cases without any complications. We were able to perform an airway examination down to the third order bronchi with targeted bronchial washings that were sent for culture and GeneXpert MTB/RIF. One patient tested positive for TB, while the rest were negative. DISCUSSION: The Ambu® aScope™ 3 SUFB was easy to set up and use. Images obtained were acceptable and allowed for systematic evaluation of the tracheobronchial trees in all cases. A diagnosis of pulmonary TB was established in one patient, who had a negative AFB smear initially, while the rest were diagnosed with sputum negative TB based on clinical criteria. Surveys in The Gambia have reported a high frequency of sputum negative PTB which is consistent with our findings.The total cost for the Ambu® aView™ reusable monitor was US$6000 while the Ambu® aScope™ 3 SUFB was US $178 per unit. In comparison, the estimated cost for an RFB setup from a regional vendor was US$51925 (excluding maintenance and repair). CONCLUSIONS: SUFB can be used in resource constrained settings in SSA with good performance characteristics, making it a viable option for health systems in the region. Despite the comparatively lower initial cost, low risk of cross-infection and maintenance advantages relative to RFB, current pricing still places this technology out of the reach of many health systems in SSA. REFERENCE #1: Obaseki, D., Adeniyi, B., Kolawole, T., Onyedum, C. & Erhabor, G. Gaps in capacity for respiratory care in developing countries. Nigeria as a case study. Ann. Am. Thorac. Soc. 12, 591–598 (2015). REFERENCE #2: Wahidi MM, Shojaee S, Lamb CR, et al. The use of bronchoscopy during the COVID-19 pandemic: CHEST/AABIP guideline and expert panel report [published online May 1, 2020]. CHEST. REFERENCE #3: Marshall, D. et al. Experience With the Use of Single-Use Disposable Bronchoscope in the ICU in a Tertiary Referral Center of Singapore. J. Bronchol. Interv. Pulmonol. 24, 136–143 (2017). DISCLOSURES: No relevant relationships by Baboucarr Sanyang, source=Web Response No relevant relationships by Jayne Sutherland, source=Web Response No relevant relationships by Sunkaru Touray, source=Web Response