Role Of Flexible Bronchoscopy Research Articles

Role of Flexible Bronchoscopy using Biopsy Forceps as the Initial Attempt for Headscarf Pin Aspiration Extraction.

Flexible bronchoscopy is a less invasive procedure for extracting foreign bodies from the airways. However, studies on the extraction of headscarf pins are still very limited to determine the efficacy and safety of headscarf pin extraction using flexible bronchoscopy with biopsy forceps. This retrospective study was conducted at Persahabatan Hospital, Jakarta, Indonesia, on patients who had been treated in this hospital for headscarf pin extraction between January 2013 and February 2023. Fibreoptic bronchoscopy was performed under general anaesthesia. The pin was removed using Radial Jaw 4 mm single-use pulmonary biopsy forceps. The impacted sharp tip of the pin was freed first, and the proximal part of the pin body was gripped using biopsy forceps. Once a firm hold of the sharp end or the proximal part of the pin was secured, the bronchoscope and forceps were both slowly withdrawn under direct vision. Thirty-two cases with headscarf pin aspiration were managed by fibreoptic bronchoscopy. A total of 12 patients (37.5%) came without any respiratory complaints; however, an equal number complained of cough and 6 cases (18.7%) of haemoptysis. All the cases in which the pins were visible in the airway were found with the round head down and the sharp tip oriented superiorly in the airway and impacted in the mucosa. Fibreoptic bronchoscopy extraction succeeded in 31 cases (96.8%). Only one case was converted to surgery. There were no major complications. Fibreoptic bronchoscopy with biopsy forceps under general anaesthesia is safe and effective for the removal of headscarf pin aspiration.

The role of flexible bronchoscopy in the diagnostic pathway of children with unexplained peripheral eosinophilia.

Many possible underlying causes can be seen in children with unexplained peripheral eosinophilia (UPE) with suspected pulmonary involvement. Here, we aimed to demonstrate the clinical characteristics and diagnoses of children evaluated for UPE who underwent diagnostic bronchoscopy. Thirty-one children who underwent diagnostic bronchoscopy for UPE between 2006-2018 were included. Demographic characteristics, bronchoscopy findings and final diagnosis, and treatments were evaluated. The median age at the time of diagnosis was 5 (0.25-17.5) years. The final diagnoses of 26 patients were as follows: immunodeficiency (n=6); hyper-IgE syndromes (n=4), DOCK8 deficiency + HES (idiopathic hypereosinophilic syndrome; n=1), and severe combined immunodeficiency (n=1), HES (n=3), idiopathic chronic eosinophilic pneumonia (ICEP; n=3), idiopathic pulmonary hemosiderosis (n=1), B cell lymphoma (n=1). In one child, an integrin α3 mutation + cytomegalovirus (CMV) pneumonia was detected. Congenital pneumonia was found in one patient, and parasitic infection in another. In two, eosinophilia was attributed to underlying asthma and atopy. In four, the underlying reasons could not be elucidated. Two children with HES and one with ICEP were lost to follow-up. There was no significant relationship between the peripheral eosinophil count at the time of diagnosis and the percentage of bronchoalveolar lavage eosinophils (BAL). Bronchoscopy contributed to the management of 14 (53.9%) patients. Bronchoscopy has potential diagnostic contribution in patients with UPE suspected of having pulmonary involvement. Numerous various underlying causes may be present in this patient group. There is no relation between peripheral eosinophil count and BAL eosinophil percentage.

Spectrum of Intrabronchial Mass Lesions and Role of Flexible Bronchoscopy in Their Diagnosis: A Series of 74 Cases

Variety of benign and malignant lesions of respiratory system presents as intrabronchial mass lesions. Present study was carried out to study the spectrum of intrabronchial lesions and role of flexible flexible bronchoscopy in their diagnosis. Retrospective study of case-records of patients with intrabronchial mass lesions diagnosed by flexible bronchoscopy, bronchial washings and bronchial biopsy between January 2004 and June 2006. Out of the 696 flexible bronchoscopies done during the study period, intrabronchial mass lesions were evident in 74 patients (10.6%) (age range 21-86 years; 60 males). Fifty (68%) lesions were malignant, eighteen (24%) lesions were benign while six (8%) lesions were inconclusive. Diagnostic yield was about 92%; repeat bronchoscopy for inconclusive results improved the diagnostic yield. Though malignant lesions are common, benign lesions remain important causes of intrabronchial mass lesions. Bronchoscopy with adequate sampling is an essential diagnostic modality for confirming the diagnosis of such lesions.

The role of flexible bronchoscopy in children with Mycoplasma pneumoniae pneumonia.

To explore the effectiveness of flexible bronchoscopy in pediatric Mycoplasma pneumoniae pneumonia (MPP). This retrospective cohort study included children with MPP admitted between 2016 and 2019 in Shanghai. Tracheobronchial manifestations, etiologic findings, therapeutic effect, and health-economic indicators were assessed in bronchoscopy (plus bronchoalveolar lavage (BAL)) and non-bronchoscopy group. We used propensity-score matching and multivariable logistic regression to investigate the effect of bronchoscopy and BAL on disease recovery. In 900 children with MPP, 24/278 (8.6%) of those who underwent bronchoscopy had sputum plugs. Coinfection rate was four-fold enhanced by BAL (19.6% vs. 4.5%, p < 0.01) in patients with severe MPP (SMPP) and nearly doubled (10.8% vs. 5.9%, p = 0.03) in those without SMPP, compared with no BAL. Total of 224 (24.9%) patients had multilobar consolidation; after BAL, a significantly shorter lesion-resolution duration was observed on imaging (OR: 0.2, 95% CI: 0.0-0.7). However, longer fever duration (OR: 2.8, 95% CI: 1.7-4.8), hospital stay (OR: 3.1, 95% CI: 1.9-5.1), and higher costs were found in the bronchoscopy group than in the non-bronchoscopy group. Through BAL, coinfection may explain one-fifth of causes for SMPP. Bronchoscopy with BAL may increase the detection rate of pathogen and resolve pulmonary lesions in patients with multilobar consolidation. Flexible bronchoscopy with bronchoalveolar lavage is of great assistance in the timely detection of coinfection, sputum plug and inflammatory polyps in children with Mycoplasma pneumoniae pneumonia (MPP), and improves the recovery of lung damage in MPP patients with multilobar consolidation. This study provides new insights into the indications of flexible bronchoscopy for the diagnosis and treatment of pediatric patients with MPP.

Tracheostomy decannulation in severe acquired brain injury patients: The role of flexible bronchoscopy

Introduction and objectivesSubjects with severe acquired brain injury (sABI) require long-term mechanical ventilation and, as a consequence, the tracheostomy tube stays in place for a long time. In this observational study, we investigated to what extent the identification of late tracheostomy complications by flexible bronchoscopy (FBS) might guide clinicians in the treatment of tracheal lesions throughout the weaning process and lead to successful decannulation. Subjects and methodsOne hundred and ninety-four subjects with sABI admitted to our rehabilitation unit were enrolled in the study. All subjects received FBS and tracheal lesions were treated either by choosing a more suitable tracheostomy tube, or by laser therapy, or by steroid therapy, or by a combination of the above treatments. ResultsOverall, 122 subjects (63%) were decannulated successfully. Our subjects received 495 FBSs (2.55 per subject) and as many as 270 late tracheostomy complications were identified. At least one complication was found in 160 subjects (82%). In only 11 subjects, late tracheostomy complications did not respond to the treatment and were the cause of decannulation failure. ConclusionsIn conclusion, in sABI patients FBS is able to guide successful tracheostomy weaning in the presence of late tracheostomy complications that could get in the way decannulation.

The role of flexible bronchoscopy in the upper airway pathology of immunosuppressed patients

The role of flexible bronchoscopy in the upper airway pathology of immunosuppressed patients

Role of flexible bronchoscopy in the diagnosis of invasive fungal infections.

There are sparse data on the role of flexible bronchoscopy (FB) in diagnosing invasive mould infections (IMIs). To investigate the safety and usefulness of FB in IMI. We evaluate the factors associated with a successful diagnosis of IMI using FB. Further, we compare subjects of invasive pulmonary aspergillosis (IPA) with pulmonary mucormycosis (PM). We retrospectively reviewed the clinical features, imaging data, bronchoscopy, microbiology and pathology details of subjects who underwent FB for suspected IMI. We categorised FB as diagnostic if it contributed to the diagnosis of IMI. We performed a multivariate analysis to identify the factors associated with a diagnostic bronchoscopy. Of the 3521 FB performed over 18months, 132 (3.7%) were done for suspected IMIs. We included 107 subjects for the final analysis. The risk factors for IMI included renal transplantation (29.0%), diabetes (27.1%), haematological malignancy (10.3%) and others. We found bronchoscopic abnormalities in 33 (30.8%) subjects, and these were more frequent in those with confirmed PM (67%) than IPA (27%). IMI was confirmed in 79 (14 proven, 48 probable and 17 possible) subjects. FB was diagnostic in 71%. We experienced major complications in three cases (2.7%), including one death. On multivariate analysis, the visualisation of endobronchial abnormalities during FB (OR [95%, CI], 8.5 [1.4-50.4]) was the only factor associated with a diagnostic FB after adjusting for age and various risk factors. Flexible bronchoscopy is a useful and safe procedure in diagnosing IMIs. The presence of endobronchial abnormalities predicts a successful diagnostic yield on FB.

Clinical and radiological profile of patients with endobronchial lesions

Background: Variety of benign and malignant lesions of respiratory system presents as endobronchial lesions. Present study was carried out to study the spectrum of endobronchial lesions and role of flexible bronchoscopy in their diagnosis. Methodology: Retrospective study of case-records of patients with endobronchial lesions diagnosed by flexible bronchoscopy, bronchial washings and bronchial biopsy between January 2016 and October 2017. Results: Out of the 131 flexible bronchoscopies done during the study period, endobronchial lesions were evident in 32 patients (age range 10-85 years; 22 males). Twelve (37.5%) lesions were malignant; six (18.75%) lesions were benign, while 14 (43.75%) lesions were inconclusive. Conclusions: Though malignant lesions are common, benign lesions remain important causes of endobronchial lesions. Bronchoscopy with adequate sampling is an essential diagnostic modality for confirming the diagnosis of such lesions. Keywords: Bronchoscopy; Computed tomography; Endobronchial lesions.

The Role of Flexible Bronchoscopy in Swab-negative Patients During the SARS-CoV2 Pandemic.

The Role of Flexible Bronchoscopy in Swab-negative Patients During the SARS-CoV2 Pandemic.

El papel de la broncoscopia flexible en la patología de vía aérea superior de pacientes inmunodeprimidos

El papel de la broncoscopia flexible en la patología de vía aérea superior de pacientes inmunodeprimidos

Role of flexible bronchoscopy in ICU setting – 3 year study

Flexible bronchoscopy (FB) is a powerful investigatory tool in patients with respiratory diseases. FB helps in direct visualisation of the upper and lower airways and has role in management of various pulmonary disorders. Its utility in critical care is increasing owing to its diagnostic and therapeutic role. This study aimed at understanding the clinical profile of critically ill ICU patients who required bronchoscopy during ICU stay. Data included demographics, indications, complications and microbiological isolates.This is a retrospective observational study conducted in 53 patients admitted at multidisciplinary ICU of a tertiary care teaching hospital, who required ICU bronchoscopy as an investigatory tool. Bronchoscopy was performed by consultants of Department of pulmonary medicine who are trained in performing flexible bronchoscopy. There were total 53 patients who required ICU bronchoscopy. Mean age of the study population was 58.08 years with standard deviation of 13.16. Maximum age of study subject was 82 years and minimum age was 21 yrs. Out of 53 subjects 35 were males (66%) and 18 were females (34%). 62.3% of subjects were on mechanical ventilator during procedure. There were complications like hypoxemia, bleeding, hypotension with zero mortality. BAL was the commonest procedure performed. There was no statistical correlation between the indication and complications, and also no correlation between age and the complication. Data was entered into Microsoft excel sheet and data analysed using Statistical Package for Social sciences (SPSS) version 16. Descriptive statistics such as frequency, percentage, mean and standard deviations were used. Quantitative data are expressed as mean ± SD, whereas qualitative data are expressed as numbers and percentages (%). Chi square test was used to find the statistical significance and p&amp;#60;0.05 was considered as statistically significant. Improved knowledge and awareness of the anatomy and procedure skills make FB a safe procedure even in high risk patients. This article highlights safety and benefits of FB in critically ill patients.

Diagnosis of Peripherally Located Bronchogenic Carcinoma: Utility of Non-Guided Flexible Bronchoscopy

The role of flexible bronchoscopy in diagnosis of peripheral pulmonary neoplasia remains controversial

Histopathological patterns of endobronchial lesions and the role of flexible fiberoptic bronchoscopy in their diagnosis

Background Flexible bronchoscopy has become the most commonly used invasive procedure in pulmonary medicine used for diagnosis of multiple lesions of respiratory system presenting as endobronchial mass lesions, either benign or malignant in nature.Aim The aim was to detect the histopathological patterns of endobronchial lesions and the role of flexible bronchoscopy in their diagnosis.Patients and methods This is a retrospective study of bronchoscopy reports especially with endobronchial mass lesions diagnosed by fiberoptic bronchoscopy, which was performed at Chest Department, El-Hussein University Hospital, Al-Azhar University, over a period of 5 years from January 2012 to December 2016.Results The fiberoptic bronchoscopy was helpful in the diagnosis of endobronchial mass lesions in 65 (28.7%) patients of 350 patients who underwent bronchoscopy during this period. Their age ranged from 15 to 80 years. The patients comprised 35 males and 30 females. Overall, 42 (65%) lesions were malignant, 18 (28%) lesions were benign, whereas five (7%) lesions were inconclusive. Diagnostic yield was ∼92.3%. Repeat bronchoscopy for inconclusive results improved the diagnostic yield.Conclusion Fiberoptic bronchoscopy is the most important tool in pulmonary medicine used in the diagnosis of malignant as well as benign lesions that present as endobronchial mass lesions that mimic each other on visual impression, and thus adequate sampling is an essential diagnostic modality for confirming the diagnosis of such lesions.

Flexible bronchoscopy in pulmonary diseases in children with congenital cardiovascular abnormalities.

There is a lack of data describing the role of flexible bronchoscopy (FB) in evaluating pulmonary diseases in children with congenital cardiovascular abnormalities in China. Determining whether those children suffer from respiratory complications may be useful for future preoperative planning and family counseling. The present study aimed to investigate the features and FB-associated findings with respect to pulmonary diseases in children with congenital cardiovascular abnormalities. The role of FB in guiding the treatment and safety of procedures was also evaluated. A cohort of 57 children with congenital cardiovascular abnormalities underwent FB for pulmonary diseases between November 2013 and June 2015. The demographics, bronchoscopy diagnoses, cellular analysis and microbiology of bronchoalveolar lavage fluid (BALF), and the clinically valuable contributions and side-effects of FB were analyzed retrospectively. The bronchoscopies were performed in patients with a median age of 4 months (range, 9 days-9 years) and 9 patients were intubated and mechanically ventilated. The most common types of congenital cardiovascular abnormalities were atrial septal defect, ventricular septal defect and patent ductus arteriosus. External compression of airways, tracheobronchomalacia, laryngomalacia, and airway narrowing were the most common airway abnormalities revealed by FB. BALF cellular analysis revealed an elevated total cell count and neutrophil percentage; 19.2% specimens harbored an etiological agent. FB findings contributed towards the clinical management of 26.3% patients. The complications of FB were mild and transient. In the present study, the majority of patients with cardiovascular abnormalities exhibited other airway disorders. The present findings suggest that FB was a useful and safe tool in the evaluation of this specific group of children.

Role of flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis.

Pulmonary tuberculosis is one of the major health concerns in the developing countries. Isolation of acid-fast bacilli (AFB) or tuberculosis bacilli from the sputum is required for the diagnosis. A proportion of suspected pulmonary tuberculosis (PTB) cases either clinically or radiologically will not produce sputum or will have sputum negative for AFB. These subsets of cases pose a diagnostic challenge to the treating clinicians. In this study, we present our experience and outcomes with flexible bronchoscopy in patients with sputum-negative pulmonary tuberculosis. This was a prospective cross-sectional study, conducted at SDS Tuberculosis research Centre and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, India, from 2010 to 2016. A total of 1095 flexible bronchoscopies were done during this period, out of which 180 were patients with sputum negative for AFB, but were strongly suspected to have pulmonary tuberculosis on clinical examination or radiologically. There were 106 males and 74 females. The age ranged between 11 and 68years. All patients underwent complete evaluation of the tracheobronchial tree followed by bronchoalveolar lavage (BAL). Microbiological studies used were Ziehl-Neelsen (ZN) staining and culture in Lowenstein-Jensen (LJ) medium. Mucosal lesions suspected of tuberculosis were subjected to biopsy and histopathological confirmation. The data was analyzed. Out of 180 patients, 106 (58.88%) cases had positive AFB smear on BAL. The culture confirmed the diagnosis of pulmonary tuberculosis in 120 cases (66.66%). Histopathology showed caseous granuloma in 38 (42.22%) cases, nonspecific inflammation in 40 (44.44%) cases, and malignancy in 12 (13.33%) cases out of 90 cases, who underwent biopsy. There were no post-procedural complications. Bronchoscopy is the useful tool in the diagnosis of pulmonary tuberculosis in patients with sputum-negative pulmonary tuberculosis. It is also helpful in differentiating conditions having the clinical picture that mimics pulmonary tuberculosis.

Foreign body aspiration in children and role of flexible bronchoscopy: A 3 year experience

BackgroundFlexible airway bronchoscopy is an accepted and frequently performed procedure in the evaluation of children with known or suspected airway and lung parenchymal disorders. MethodsBetween 2012 and 2015, retrospective analysis of 134 flexible bronchoscopies was done in Children’s Hospital, Cairo University, as regards demographic profile, clinical and radiological presentation and diagnostic indication. The results were analyzed on the basis of bronchoscopy inspection, conclusion and future recommendations. ResultsPatients indicated for flexible bronchoscopy presented clinically with unilateral diminished breath sounds in 24.6%, unilateral bronchial breathing in 17.9%, recurrent lower respiratory tract infection in 11.2%, persistent cough in 4.5% and stridor in 9.7%, others showed radiological findings in the form of unilateral hyperinflation in 9%, bronchiectasis in 3.7% and unilateral wheezes in 1.5%. Out of 134 patients undergoing bronchoscopy, 38% had foreign body (FB) in the airways although only 7.5% of patients had recalled a previous history of FB aspiration (15.6% in the trachea, 52% in the right side and 31.3% in the left side, among those patients 60.8% were males while 39.2% were females), 14.1% had tracheal abnormality, 26.8% had post inflammatory changes, 56.7% had right bronchus abnormality, 55.2% had left bronchus abnormality, bronchoalveolar lavage (BAL) was done in 30.6% of patients, FB was successfully removed in 15.6% of patients and further cardiothoracic intervention was needed in 29.8% of patients. ConclusionThe combination of history, physical examination, and chest X-ray findings are crucial when investigating a child with suspected foreign body aspiration. Flexible bronchoscopy is effective for diagnostic and sometimes therapeutic purpose of problems in the upper and lower respiratory airways in children, with a high success rate as it significantly reduces the rate of negative rigid bronchoscopies and ultimately saves the child from undergoing an unnecessary procedure.

Translational research in pediatrics III: bronchoalveolar lavage.

The role of flexible bronchoscopy and bronchoalveolar lavage (BAL) for the care of children with airway and pulmonary diseases is well established, with collected BAL fluid most often used clinically for microbiologic pathogen identification and cellular analyses. More recently, powerful analytic research methods have been used to investigate BAL samples to better understand the pathophysiological basis of pediatric respiratory disease. Investigations have focused on the cellular components contained in BAL fluid, such as macrophages, lymphocytes, neutrophils, eosinophils, and mast cells, as well as the noncellular components such as serum molecules, inflammatory proteins, and surfactant. Molecular techniques are frequently used to investigate BAL fluid for the presence of infectious pathologies and for cellular gene expression. Recent advances in proteomics allow identification of multiple protein expression patterns linked to specific respiratory diseases, whereas newer analytic techniques allow for investigations on surfactant quantification and function. These translational research studies on BAL fluid have aided our understanding of pulmonary inflammation and the injury/repair responses in children. We review the ethics and practices for the execution of BAL in children for translational research purposes, with an emphasis on the optimal handling and processing of BAL samples.

Bronchoscopy in Pulmonary Hydatidosis

The diagnosis of unruptured pulmonary hydatidosis is based on classical radiologic features. However, ruptured or complicated hydatid cysts alter the radiologic signs and lead to delayed or incorrect diagnosis. The role of flexible bronchoscopy was assessed as a diagnostic tool in the evaluation in such cases. Between 2002 and 2008, 14 patients (7 female, 7 male), aged between 18 and 55 years, with a mean age of 36 years, were evaluated for pulmonary hydatidosis. Clinical history, radiologic findings, and other investigations of the patients were reviewed retrospectively at a tertiary referral center. All 14 patients were symptomatic, with cough, hemoptysis, and chest pain being the most common symptoms. Seven patients had right lung involvement, whereas 6 patients had left-sided predilection, and the remainder presented with pleural disease. At flexible bronchoscopy, white glistening membrane could be observed in 9 patients, whereas cytologic evaluation of bronchial washing did not show cuticular particles, degenerated scoleces, or hooklets in any of the cases. Twelve patients underwent uneventful surgical intervention. Surgical specimens showed 2 unruptured pulmonary hydatid cysts (uncomplicated), 1 pleural hydatid, and 9 ruptured pulmonary hydatid cysts. Of the 9 ruptured hydatid cyst cases, evidence of fungal (aspergillus) colonization, bacterial infection, and coexistent tuberculous granuloma was reported in 2 cases each. Bronchoscopy is an important tool that aids in confirming the diagnosis before surgery, especially in complicated pulmonary hydatidosis. Special stains for cytologic specimen should be used if the possibility of ruptured hydatid is thought to improve the diagnostic yield. The histopathology of the surgical specimen should be reviewed for associated secondary infection and fungal colonization.

Management strategies in foreign-body aspiration

The aim of this study is to outline a management algorithm to ensure effective teamwork in decreasing morbidity and mortality in pediatric Foreign-Body Aspirations (FBA). Furthermore, the role of flexible bronchoscopy when compared to rigid bronchoscopy in FBA was evaluated. Charts of patients with suspected FBA from October 1999 to September 2006 were reviewed and data with regards to the history, presenting symptoms, diagnostics and therapeutic tactics, was collected. A total of 77 children with suspicion of FBA were managed in the 7 year period. Bronchoscopies were performed in 63 patients and in 26 foreign-bodies (FB) were found and extracted. At referral, 53 patients did not present acute respiratory symptoms, but had a positive history of FBA, and in 13 FB were found. Despite negative chest x-rays in 55 patients, FB were found in 8. Rigid bronchoscopy was performed in 53 and flexible in 10 patients. In 3 out of 10 patients who had undergone flexible bronchoscopy a FB was identified, the extraction of which was performed using a rigid bronchoscope. Clinical and radiological findings in children with typical history of suspected FBA are not enough to confirm the presence of FB. Successful management with an extremely low rate of morbidity and no mortality was observed using the algorithm used at our center. Flexible bronchoscopy reduces the chances of airway tract injury; however a rigid bronchoscope is necessary for FB removal.

Bronchoscopic Myths and Legends

In Brief Esophageal cancer is only curable by surgical resection. Appropriate staging of esophageal cancer is essential in identifying which patients might benefit from surgery, while avoiding the associated morbidity and mortality of an esophagectomy in those patients in whom curative resection is not possible. We review the literature regarding the utility of flexible bronchoscopy in staging esophageal cancer. Indications for bronchoscopy are based on training experience and evidence-based medicine when available. In this article, we review the available literature on the role of flexible bronchoscopy in staging esophageal cancer.