Although previously performed using a rigid bronchoscope, the term “bronchoscopy” usually refers to flexible fiberoptic bronchoscopy. During a bronchoscopy, a flexible rubber tube that terminates with a bright light (transmitted to the tip of the scope via bundles of fiber optic material) and viewfinder (either fiberoptic or a miniature electronic camera) is utilized to perform a detailed inspection of the airways and other specialized procedures (see below).
Bronchoscopy may be done for many reasons including 1) the evaluation of an abnormal chest x-ray or chest CAT scan, 2) the evaluation of pneumonia, 3) removal of abnormal secretions or foreign bodies from the airways, 4) the evaluation of intersitial (scarring) lung disease, and 5) the evaluation of hemoptysis (blood in the sputum).
Prior to the bronchoscopy the patient should have nothing to eat or drink (except for certain medications with sips of water) starting at midnight prior to the bronchoscopy. The patient undergoes bronchoscopy in either an endoscopy suite or the operating room. Occasionally, emergency bronchoscopies are done in hospitalized patients at the bedside. After an intravenous line is started and the patient is attached to vital sign monitors, the patient is made comfortable for the procedure with both topical anesthetics (such as lidocaine jelly or spray) and may also receive sedation. Once the patient is comfortable, the bronchoscope is advanced through the nose or mouth, past the epiglottis and vocal cords, and into the trachea (windpipe). Next, the bronchoscopist performs a detailed examination of the tracheobronchial tree, starting at the right and left main bronchi, then the lobar bronchi, and finally the segmental and subsegmental bronchi.
Abnormalities of the tracheobronchial tree can be closely inspected and if necessary, biopsied. Enlarged lymph glands or other abnormal areas exterior to the bronchial tree can be accessed via transbronchial needle aspiration (Wang needle). In the transbronchial biopsy procedure, abnormal lung masses or diseased lung tissue that are not in direct view may be biopsied with the assistance of fluoroscopy. In this procedure, the biopsy forceps is directed out of the view of the bronchoscope but is followed visually into the more distant lung tissue using fluoroscopy (a “motion picture” x-ray machine). In a procedure termed bronchoalveolar lavage (BAL), small segments of the lung can be “washed out” with sterile salt-water solution. Fluid returned from BAL can be analyzed in the laboratory to assist in the diagnosis of the pulmonary disorder.
Bronchoscopy is considered a non-invasive procedure (similar to the more commonly performed upper endoscopy test that looks into the esophagus and stomach) in that no incision is required. After the patient is made adequately comfortable, the procedure takes between fifteen and thirty minutes. The procedure is generally considered quite safe. Significant bleeding or collapse of the lung are the two most common complications of bronchoscopy, each occurring less than two percent of the time. If all is well, the patient should be fully recovered within two hours. Usually, the patient is not allowed food or drink for several hours after the procedure until the local anesthetic and sedatives have fully worn off.