Bronchoscopy

1 What is a Bronchoscopy?

Bronchoscopy is a procedure that makes it possible for a doctor to look at your lungs and air passages. It is usually performed by a pulmonologist (a doctor who specializes in lung disorders).

During bronchoscopy, a thin tube known as a bronchoscope is passed through your nose or mouth, down your throat and further into the lungs.

Bronchoscopy is commonly performed using a flexible bronchoscope. However, in some cases, such as if there is a lot of bleeding in your lungs or a large object stuck in your airway, a rigid bronchoscope may be needed.

Common reasons for needing bronchoscopy are a persistent cough, infection and anything unusual seen on a chest X-ray or another test.

Bronchoscopy can also be used to obtain samples of mucus or tissue or to remove foreign bodies or other blockages from the airways or the lungs.

2 Reasons for Procedure

The main reason for bronchoscopy is to find the cause of a lung problem. For example, your doctor might refer you for bronchoscopy because you have a persistent cough or an abnormal chest X-ray.

In individuals with lung cancer, a bronchoscope with a built-in ultrasound probe may be used to check the lymph nodes inside the chest. 

This process is known as endobronchial ultrasound (EBUS) and helps the doctor determine the appropriate treatment.

EBUS may be used for other types of cancer to determine if cancer has spread. Bronchoscopy can also be used to treat some medical problems. 

It can be used to improve obstructions or tumors from the air passages or lungs, or to place a small tube to hold open an airway (airway). 

In these cases, special devices may be passed through the bronchoscope, such as a laser or electrocautery probe to control bleeding.

3 Potential Risks

Potential risks of bronchoscopy are quite uncommon and predominantly minor, although they may rarely be severed.

Complications may be related to the procedure itself or the sedative or numbing medicine.

  • Bleeding. Bleeding is more likely to occur if the airways are inflamed or damaged by disease, or if a biopsy was taken. Usually, bleeding is not severe and stops without treatment.
  • Collapsed lung. In very rare cases, an airway may be injured during bronchoscopy. If the lung is punctured, air can accumulate in the space around the lungs, which can lead to one or both of the lungs to collapse. Usually, this problem is easily corrected, but it may require admission to the hospital.
  • Fever. Fever is relatively common after bronchoscopy but is not always a sign of infection. Treatment is generally not required.

4 Preparing for your Procedure

This steps must be followed during the preparation for bronchoscopy:

  • Food and medication. You may be asked to avoid taking blood-thinning medications (including aspirin, clopidrogel [Plavix] and warfarin [Coumadin, Jantoven]) several days before your bronchoscopy. You will also be asked to not to eat or drink four to eight hours before the procedure.
  • Clothing and personal items. On the day of the bronchoscopy, you will be asked to put on a gown and take any dentures, partial dentures or bridges. You may also be asked to remove hearing aids, contact lenses or glasses.
  • Other precautions.  If you will be going home after the procedure, you will need a friend or family member to get you there. You will not have the ability to drive because of the lingering effects of the medications used during the procedure. It is also advisable to have someone stay with you for the rest of the day.

5 What to Expect

Here you can find out what to expect from your bronchoscopy procedure.

Bronchoscopy is usually done in a procedure room in a clinic or in a hospital operating room. The whole procedure, including prep and recovery time, usually takes about four hours.

Bronchoscopy on its own lasts for about 30 minutes to an hour. Before the procedure. You will be asked to sit or lie back on a table or a bed with your arms at your sides.

You will then be connected to a monitor so that the health care team can monitor your heart rate, blood pressure, and oxygen level during the procedure.

Medicine will be administered to you through a vein (intravenously) to help you relax. You will feel sleepy but will still be awake. A numbing medication will be sprayed in your throat and possible in your noses as well.

This medication, called an anesthetic, numbs the area. It helps to reduce gagging and coughing as the bronchoscope is placed in your throat. The medicine may taste unpleasant but that does not last.

During the procedure. During a bronchoscopy, a thin tube known as a bronchoscope is placed in your nose or mouth. The bronchoscope has a light and a tiny camera at its tip that displays pictures on a monitor.

The bronchoscope is slowly advanced down the back of your throat, through the vocal cords into your airways. It may feel uncomfortable, but it should not hurt.

Your health is team will try to make you as comfortable as possible. Samples of tissue and fluid may be taken using devices passed through the bronchoscope.

In that case, your doctor may ask if you have pain in your chest, back or shoulders. In general, you should not feel pain.

After the procedure. You will be monitored for several hours after bronchoscopy. You mouth and throat will probably be numb for a couple of hours.  You will not be allowed to eat or drink until the numbness wears off.

This helps prevent food from getting into the airways and lungs. When your mouth and throat are no longer numb and you have the ability to swallow and cough normally once more, you can have something to drink. Start with sips of water.

When you can swallow normally, you can eat soft foods, such as soup and applesauce. Add other foods as you feel comfortable. You may have a mild sore throat, hoarseness, cough or muscle aches. This is normal.

Warm water gargles and throat lozenges can help reduce the discomfort. Just be sure all the numbness is gone before you try sucking on lozenges or gargling. Call the doctor immediately if you:

  • Have a fever that lasts for more than a few days.
  • Have increasing chest pain.
  • Have trouble breathing.
  • Cough up more than a few tablespoons of blood.

6 Procedure Results

Your doctor will discuss with you bronchoscopy results in about one to three days after the procedure.

Your doctor will use these results to make a decision on how to treat any of the lung problems that were discovered. It is also possible that you may need other tests done.

If a biopsy was taken during the bronchoscopy, it will need to be reviewed by a pathologist. Because the tissue samples need special preparation, some results take longer than others to return.

Some biopsy specimens will need to be sent for genetic testing, which might take two weeks or more.

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