What is a bronchoscopy?

    A bronchoscopy is a procedure where a tube is inserted into the upper respiratory tract via the nose or mouth. It goes through the glottis and trachea, into the bronchi and beyond. This allows your physician to clearly visualize lesions in the trachea and bronchi, either by a display screen or using an eyepiece. The bronchoscope is equipped to take samples of tissue directly observed by your physician for biopsy, to take smears by brushing, and to perform bronchial lavage. The equipment involved allows your physician to make an accurate diagnosis and to perform treatment more easily.

    The bronchoscope is a soft and flexible tube with a small diameter, enabling a clear field of vision with a high degree of safety. The patient experiences minimal discomfort and only requires a local anesthetic. Most importantly, a bronchoscopy is the best method for diagnosing bronchial lesions. It can be used to discover lesions deep within the trachea, bronchi, and lungs that are difficult to detect that would not be found using chest CT. Diagnosis and treatment can be performed without the need to perform surgery.


    When does a bronchoscopy need to be performed?

    A bronchoscopy is needed to diagnose disease in the following circumstances:

    •   Cause of chronic cough is unknown

    •   Cause of hemoptysis or blood-stained sputum is unknown

    •   Cause of localized wheezing is unknown

    •   Cause of hoarseness is unknown

    •   Cancer cells are discovered or suspected in the sputum

    •   Chest X-ray and/or CT suggests abnormal changes such as pulmonary atelectasis, lung nodules or masses, obstructive pneumonia, unresolved inflammation, diffuse pulmonary lesions, enlargement of the hilus and/or mediastinal lymph nodes, tracheobronchial stenosis, or pleural effusion of unknown cause

    •   Reference for a preoperative lung examination, used to determine the surgical site, extent of surgery carried out, and to estimate the prognosis

    •   Confirm diagnosis of chest trauma, and laceration or rupture of the trachea or bronchi

    •   Etiological diagnosis of infectious disease of the lung or bronchi (including bronchopulmonary infection among immunosuppressed). For example, obtaining specimens for culture by tracheal suction, protected specimen brushes, or bronchoalveolar lavage (BAL)

    •   Management of the airways during mechanical ventilation

    •   Definitive diagnosis where fistulas of the trachea or bronchi are suspected

    A bronchoscopy is needed for disease treatment in the following circumstance:

    •   Remove foreign objects from the bronchi, clearing abnormal secretions from the trachea, such as sputum, pus, and blood clots

    •   Remove emboli from the bronchi and pulmonary reexpansion in the event of pulmonary atelectasis caused by embolism involving pus, sputum, or blood

    •   Confirm the location of bleeding for patients with hemoptysis, then attempting to stop bleeding locally. For example, cold saline lavage or injection with thrombin solution or dilute epinephrine solution

    •   Perform local radiation or local injection with chemotherapy drugs for patients with lung cancer

    •   Guided intubation of the airways and guided bronchial intubation where there are difficulties with intubation

    •   Laser, microwave, frozen, or high-frequency electrosurgical treatment for patients with benign or malignant tumors of the airways


    When should a bronchoscopy not be performed?

    •   Active massive hemoptysis

    •   Severe hypertension or arrhythmia

    •   Recent myocardial infarction or history of unstable angina pectoris 

    •   Severe heart or pulmonary dysfunction

    •   Bleeding disorder which cannot be corrected, such as severe coagulation dysfunction, uremia, or pulmonary arterial hypertension

    •   Severe superior vena cava syndrome

    •   Suspected aortic aneurysm

    •   Multiple pulmonary bullae

    •   State of extreme exhaustion


    What should I pay special attention to before my bronchoscopy?

    Before your bronchoscopy:

    •   Do not eat or drink for 4–6 hours

    •   Sign the consent form for surgery

    •   Maintain a stable mood, and avoid feeling nervous or worried

    •   A family member must accompany you on the day of the procedure

    •   Empty your bladder and remove your glasses and dentures

    •   Give an accurate account of your health condition and past medical history to your physician. You should rest if you have a fever or increased blood pressure, or tachycardia. Wait until your vital signs become stable before having the procedure. Remember to also let your physician know about any drug allergies, hypertrophic rhinosinusitis, snoring, throat surgery you have had done, or serious cervical vertebrae diseases you may have

    •   Take medications for illnesses strictly following the schedule provided by your physician. For example, medications for hypertension or heart disease can be taken orally two hours before the bronchoscopy and will not affect the procedure

    •   Complete your preoperative examination: This includes chest CT, ECG, FBC, check for infections pre-surgery, and blood coagulation studies. Before leaving home, be sure to bring any chest X-ray or CT images, ECG, FBC, and blood coagulation reports for your physician to look at


    During the bronchoscopy:

    Lie down facing up where possible. If you are unable to lie down facing up, you may sit upright or semirecline. You may experience some nausea, coughing, and suppression of gas as the bronchofiberscope passes through the glottis. Stay relaxed and breathe through your mouth. Do not raise your head or shake your head from side to side. Raise your hand if you feel particularly uncomfortable.


    After the bronchoscopy:

    •   Appearance of blood-stained sputum following bronchoscopy is normal. See your doctor immediately if there is a significant amount of hemoptysis, bloody sputum, intense chest pain, difficulty breathing, recurring fevers, or arrhythmia

    •   Rest well and avoid talking to reduce hoarseness and a painful throat or chest

    •   Do not eat or drink for 2–3 hours following the procedure. Try drinking some warm water 3 or more hours after the procedure. If you are not choking or coughing, you can eat some cool, mild food

    •   Wait outside the examination room after your procedure for at least 30 minutes to ensure that you are not experiencing any dizziness or other symptoms before you leave the hospital


    Is a bronchoscopy dangerous?

    A bronchoscopy is a relatively safe procedure. Complications may occur (such as allergies to anesthetics, laryngeal edema, cramps in the airways, hypoxia, infections, bleeding, pneumothorax, and cardiocerebral events), however the chance of them occurring is low, and your physician will actively respond if such events occur. Your physician will perform strict checks, especially before the procedure, for indications and contraindications, to ensure that you are prepared. During the procedure, your physician will perform close monitoring, and respond immediately to any symptoms, reducing the risk of complications, and ensuring that the procedure is safe and effective.


    Why is fluorescence bronchoscopy necessary?

    Autofluorescence bronchoscopy (AFB) is a new type of bronchoscopy procedure combining regular white light bronchoscopy (WLB) with cell autofluorescence and information technology. This equipment stimulates cell fluorescence, to determine differences in cell fluorescence. The principle behind it is that dysplasia and microinvasive carcinoma of the bronchial epithelium occurs during blue laser exposure creates a weaker red fluorescence and weaker green fluorescence compared with normal tissue. This makes lesions appear in a reddish brown color whereas normal tissue appears green. Computer-aided imaging techniques enable such lesions and their extent to be identified. AFB is unique compared with other microscopic techniques, as it allows discovery of extremely minute lesions, therefore increasing the sensitivity and accuracy of biopsies carried out via bronchoscopy.

    As with regular bronchoscopies, AFB is suitable for screening and diagnosis for patients at high risk of developing lung cancer and central type lung cancer in its early stages: This includes asymptomatic individuals at high risk of developing lung cancer (people 45 years old or above, a smoking index of ≥ 400, abnormal sputum cytology results), outpatients with a high risk of developing lung cancer, and people who have normal chest imaging results but often cough or have blood in their sputum and have a high risk of developing lung cancer. AFB is also suitable as a preoperative examination or follow-up examination for lung cancer, useful in determining the scope of surgery prior to a procedure, avoiding resection line involvement, and in the early discovery of relapse and local metastasis following surgery.


    Reference

    中华医学会呼吸病学分会:诊断性可弯曲支气管镜应用指南(2008年版)

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