Bronchoscopy is a technique of endoscopic visualization of the tracheobronchial tree using an optical device – a rigid or flexible bronchoscope. In pulmonology, bronchoscopy is performed according to diagnostic and therapeutic indications. Diagnostic bronchoscopy is aimed at detecting a tumor or inflammatory process, malformations of the bronchial tree, finding out the causes of hemoptysis, taking a biopsy and sputum for examination, etc. Therapeutic bronchoscopy is performed in order to extract foreign bodies, sanitize the bronchi, administer medications, remove bronchial adenomas, eliminate obstructive bronchial obstruction, etc.
Taking into account the type of endoscope used, flexible and rigid (rigid) bronchoscopy are distinguished. During rigid bronchoscopy, an inflexible tube is used and, as a rule, general anesthesia. With the help of this variant of bronchoscopy, foreign bodies are removed from the respiratory tract, the bronchial tree is examined with severe bleeding. Flexible with a bending fibrobronchoscope allows you to examine the distal bronchi and perform a larger volume of therapeutic and diagnostic manipulations using local anesthesia. The price varies depending on the type of examination (rigid, flexible), goals and additional manipulations. Before planning a bronchoscopy, lung radiography, ECG, and coagulogram are required.
Diagnostic bronchoscopy is carried out with a clarifying purpose for radiologically determined lung tumors with endobronchial or peribronchial growth, tracheal formations, tuberculosis, bronchial stenosis, bronchiectasis, bronchitis, abnormalities of the tracheobronchial tree, purulent destructive processes (abscess, lung gangrene). This method of diagnostic can be prescribed based on clinical symptoms: persistent unmotivated cough, the release of copious or fetid sputum, bleeding or hemoptysis, shortness of breath.
During diagnostic bronchoscopy, not only a visual examination of the internal lumen of the tracheobronchial tree is performed, but also the collection of diagnostic material – pathological secretions, a piece of tumor, flushes from the bronchi, a transbronchial lung biopsy, etc. Samples of the material obtained during bronchoscopy are examined by cytological, bacteriological, histological methods.
Modern pulmonology uses bronchoscopy for therapeutic purposes for bronchoalveolar lavage and tracheal aspiration, performing endoscopic operations – extraction of foreign bodies from the lumen of the airways, stopping bleeding, removal of tumors in the bronchial lumen, expansion and endoprosthetics of stenosed trachea / bronchus with a stent, transbronchial drainage of lung abscess, elimination of postoperative atelectasis and hypoventilation of the lungs, etc. The price of medical, surgical and diagnostic bronchoscopy can be different in one institution. Control diagnostic is performed after resection of the lungs and bronchi, endoscopic removal of tumors.
Limitations of bronchoscopy may be associated with the severity of background pathology – high arterial hypertension, arrhythmia, epilepsy, schizophrenia, recent myocardial infarction, TBI, stroke, disorders of the coagulation system, coronary heart disease, pulmonary heart failure. Rigid technically cannot be carried out with ankylosis of the lower jaw, damage to the cervical vertebrae, pronounced stenosis of the larynx or trachea.
Methodology of conducting
In order to avoid accidental aspiration of gastric contents into the respiratory tract during coughing and vomiting, this method of diagnostic is performed after an 8-10-hour period of hunger. Before diagnostic, removable dentures should be removed, the tight collar of clothing should be loosened.
When performing flexible bronchoscopy, anesthesia of the oropharynx and nasal passages is performed using an aerosol lidocaine spray to reduce the cough reflex and discomfort when conducting a fibrobronchoscope through the nose. 5-7 minutes after anesthesia, the endoscopist begins the bronchoscopy itself. During the bronchoscopy, the patient usually sits on a chair. A flexible fibrobronchoscope is inserted through the nasal passage or mouth, equipped with a video camera and illumination, and moves into the respiratory tract under the control of optics. When reaching the bronchi, there are strong urges to cough. The patient should be aware that due to the small diameter of the fibroendoscope (smaller than the bronchial lumen), asphyxic complications of bronchoscopy are excluded.
During diagnostic, the surface of the trachea and bronchi is examined sequentially, paying attention to the state of the mucosa (color, severity of vascular pattern and folds), mobility of the walls of the bronchi, the nature of the secretion. Normally, bronchoscopy shows a pale pink or slightly yellowish mucosa with a matte surface and moderately pronounced folds. When examining the trachea and large bronchi, the vascular pattern is clearly discernible, the contours of the cartilaginous rings and inter-cartilaginous spaces are clearly outlined. The walls of the bronchi and trachea (especially in the membranous part) are mobile when breathing.
With inflammation of the bronchial mucosa during bronchoscopy, hyperemia and swelling of the walls, erasure of folds and vascular pattern, accumulation of mucous, purulent or mucopurulent secretions inside the bronchi are noted. Atrophic changes of the bronchi during bronchoscopy are characterized by increased folding, thinning of the mucous membrane through which the vessels are visible, expansion and yawning of the bronchi. Detection of malignant lung tumors during bronchoscopy is possible on the basis of direct (in the case of endobronchial growth) or indirect (in the case of peribronchial growth) signs. With peribronchial localization of tumors, the lumen is deformed, the mobility of the bronchial wall changes, the local pattern of blood vessels and folding.
An experienced bronchologist, who knows the endoscopic features of the norm and pathology, may suspect specific signs of a particular deviation during bronchoscopy. After the examination and the necessary manipulations (diagnostic, rehabilitation, operating), bronchoscopy is completed by removing the endoscope. Eating is allowed after the disappearance of sensations of numbness of the nasopharyngeal mucosa.
Hoarseness and nasal voice, the urge to cough persist for several hours after bronchoscopy. With early intake of fluids or food, they may enter the trachea. With a biopsy or removal of endobronchial tumors, there is a possibility of bleeding. If a trans-bronchial lung biopsy is performed during bronchoscopy, there is a risk of mediastinal emphysema or pneumothorax. Hypoxia and arrhythmias may develop in patients with initial pulmonary heart failure during bronchoscopy. With bronchial asthma, there is a danger of laryngospasm or bronchospasm.
In case of correct risk determination, bronchoscopy and anesthesia options, as well as with the high professionalism of the bronchologist, complications practically do not occur. Nevertheless, in a number of non-standard situations, bronchoscopy may require emergency surgical or resuscitation care.