Bronchoscopy is a medical procedure that is used to diagnose respiratory diseases. During its implementation, the specialist has the opportunity to examine the mucous membranes of the trachea and bronchi, take the material for research and make therapeutic manipulations. Such a wide range of actions is provided by a special device equipped with a video camera – a bronchoscope. Bronchoscopy has a high degree of informativeness, allows to diagnose diseases of the respiratory tract, if other methods of examination have not built a complete picture.
Types of bronchoscopy
To clarify the causes of the occurrence of the disease, determine the prevalence of the process, if cancer is suspected, a material is sampled during bronchoscopy – a biopsy. The study is conducted in various ways, each of which is indicated for certain types of diseases. After the procedure, the material is sent for research on cytology and histology. How long to wait for the results depends on what laboratory diagnostic measures are assigned for the obtained piece of tissue. Types of biopsy:
- Endobronchial. A catheter is inserted into the bronchi through which a special medical solution is allowed. After it is exhausted, the liquid is immediately sent to the laboratory for examination.
- Tongs. It is performed using a flexible bronchoscope. The endoscopist leads a forceps through the canal of the instrument and cuts off a piece of the tumor. The procedure is carried out after a preliminary examination of the pathological area. When the device tweaks, it is carefully removed from the bronchoscope. The obtained piece of tissue is used as a material for histological examination, and also smears are made from it to check for cytology.
- Brush Biopsy. For this type of fence, a special brush is used, which makes several movements of scrape. After manipulation, the device is immediately removed, smears are removed from the surface of the brush for further research.
- Catheter. Biopsy is designed to take a liquid material for diagnosis. A catheter is inserted into the bronchus, the contents are aspirated using suction. The resulting material is placed on special glass.
- Endobronchial. Indications for its implementation – diffuse pathological lesions of the bronchial tree, registration of peripheral-type infiltrates in the lung tissue. The forceps are inserted into the affected area more strongly than others, until the patient feels a slight injection. The fence occurs during expiration.
- Puncture. Conducted with tumors, lymph nodes. Through a bronchoscope specialist introduces a special needle, which is no more than half a centimeter immersed in the shell of the bronchus. A vacuum is created due to which the contents of the lymph node are aspirated. The procedure takes place several times to obtain the required amount of biomaterial.
- BALL. Bronchoalveolar lavage is the introduction through the catheter into the bronchus saline with an acidity of 7.2-7.4, heated to 40 degrees, in an amount of 100-200 ml. The fluid is delivered to the bronchus in portions. At the end of the procedure, the solution is aspirated along with trapped bronchial fluid and undergoes immediate laboratory testing.
Together with traditional endoscopy, an x-ray method of bronchus – bronchography is sometimes performed. During the procedure, the studied areas of the bronchial tree are filled with a contrasting substance, after which pictures are taken in the supine and side lying position. After X-ray contrast is displayed through the catheter, and the patient coughs up the rest independently. Bronchography is shown when it is detected in the lungs of cavities of unknown origin, a decrease in the respiratory organ, and inflammatory processes of a chronic nature.
Also patients with respiratory diseases are assigned non-invasive virtual bronchoscopy. This is a method of tomographic computer research, which, thanks to the display of pictures of the respiratory organs in three-dimensional mode, is able to register adverse changes in the bronchial tree. The procedure helps to determine exactly where the pathology is localized, but there is no possibility of medical intervention, taking material for further research.
Bronchoscopy is prescribed to patients for various reasons. The study is conducted to clarify the preliminary diagnosis, if there are symptoms of pathological processes in the bronchi, as well as in the case when the X-ray results showed possible damage to the respiratory organs. The main indications for bronchoscopy with clinical symptoms:
- Prolonged cough, which is the only sign of the disease;
- A cough that lasts a long time, the appearance of which cannot be explained by a diagnosed disease;
- Permanent inflammation of the bronchi – for example, in chronic obstructive pulmonary disease (COPD);
- Any lesions of the respiratory tract, preliminary studies which did not make it possible to make a final diagnosis or to clarify it, the results of bronchoscopy are necessary;
- Pulmonary hemorrhage;
- Suspected tuberculosis and fistula;
- Strong quantitative changes in sputum in a short period of time.
Also, bronchoscopy is done in cases when it is necessary to investigate a biomaterial (liquid, a piece of bronchus tissue or neoplasm) for cytology and histology. Radiographic signs requiring bronchoscopy: narrowing of the bronchial lumen, reducing or changing the shape of the respiratory organs, pneumothorax, poor ventilation, prolonged pneumonia, shadows in the image of unclear origin, changes in the intrapulmonary cavities in size – can serve as the first sign of an abscess or tuberculosis, pleurisy, any kind tuberculosis, a widespread lesion of the respiratory system, lung tumor.
Therapeutic bronchoscopy is performed to remove a foreign body that can cause swelling or pneumothorax. A referral to the procedure is given for the treatment of purulent bronchitis, stopping the blood flow in the bronchi using tamponade. Sanitation bronchoscopy is used for medicinal purposes, when the patient’s sputum discharge is impaired, mucus, pus and other fluids accumulate in the respiratory organs.
An important diagnostic and therapeutic role is played by emergency bronchoscopy, which is necessary when acute respiratory failure occurs due to an impaired bronchial patency. It can cause bleeding in the lungs, a large foreign body, hypoventilation, purulent blockage of passages on the background of bronchial asthma, damage to the respiratory system due to injuries of the chest. Bronchoscopy reveals the localization and nature of the pathological process and can be used to eliminate it.
Preparation for bronchoscopy: an algorithm
Patient preparation is an obligatory preliminary stage before bronchoscopy. Preparatory measures will help to avoid possible complications from invasive research, make its results more informative. First of all, it is necessary to undergo a number of additional examinations – X-ray, spirography, electrocardiography, biochemical analysis of blood and urine, coagulogram, analyzes of the level of oxygen, carbon dioxide, nitrogen and urea in the blood.
Other diagnostic measures may be recommended by a doctor. The endoscopist must rule out the presence of contraindications and allergies to drugs administered during the procedure. Rules for preparing the patient for the study after passing the necessary tests:
- The night before, if the patient is anxious, sedatives are taken – Elenium, Seduxen. In case of insomnia, hypnotics are prescribed for anxiety.
- The procedure is performed on an empty stomach and most often in the morning, so the last meal should be carried out at bedtime. Within 8 hours before the study, eating and drinking can not be anything.
- A few hours before the study, you need to empty your intestines with an enema or special candles.
- Smoking on the day of bronchoscopy is prohibited – this will reduce the information content of the procedure.
- It is necessary to prepare a clean towel, which may be necessary when the appearance of non-lasting hemoptysis after bronchoscopy, and also for expectoration of a special disinfectant solution during the study.
Patients with convulsive seizures need to take drugs against them a few days before the procedure. With diabetes, the first morning injection is skipped. Part of the preparation algorithm for bronchoscopy can be a tranquilizer in the morning, if the patient feels a strong emotion.
How is bronchoscopy done?
A bronchoscopy session is performed in a specialist’s office while sitting or lying under the supervision of medical personnel. The endoscopist is assisted by a nurse. Nursing is to disinfect the devices for research, to check the light, to provide a specialist with all the necessary materials for the procedure – tampons, syringes, medicines.
How do bronchoscopy lungs flexible tool:
- There is an introduction of drugs. Patients with reduced airway are injected with a solution of Euphyllinum, and right before the start of the study, the patient takes a portion of an aerosol bronchodilator (Salbutamol or another). Atropinization is also carried out, diphenhydramine is injected.
- Before performing bronchoscopy of the lungs, local anesthesia is performed. To remove the pain from the passage of a bronchoscope in the bronchi, use Novocain, Lidocaine and other means. If the instrument passes through the nasal cavity, the drug is injected in small portions in one nasal passage. In oral bronchoscopy, the anesthetic is sprayed onto the root of the tongue and into the oropharynx. Other areas of anesthesia occur as the bronchoscope moves through the airways.
- The algorithm for performing the procedure is that the flexible tube of the bronchoscope is inserted into the respiratory tract through the nose or mouth. The use of the instrument in the transnasal version of the study is possible only in the case when the patient has a fairly wide nasal passage. During the procedure, the patient has feelings of numbness in the throat, coma, nasal congestion. When the bronchoscope moves through the airways, the person must breathe shallowly and quickly to suppress the cough and vomiting reflex. The doctor examines the trachea, bronchi on the screen with an enlarged image, determines the localization of pathological processes, draws attention to the color of the walls of the bronchi, the type and structure of sputum. A process is being recorded.
- If necessary, the specialist takes the biomaterial for further investigation with special tools or through a catheter.
- At the end of the procedure, the doctor carefully removes the bronchoscope from the respiratory tract, clarifies the patient’s state of health, makes a description of the condition of the bronchi with a transcript and a conclusion on the proposed diagnosis.
The small diameter of the bronchoscope with a flexible tube allows local anesthesia. The technique of rigid bronchoscopy obliges doctors to carry out the procedure exclusively under general anesthesia. For this, strong anesthesia is used, which is administered intravenously or inhaled as inhalation. The technique of the study is more complex, requires additional ventilation of the lungs, the use of a laryngoscope to detect the glottis and raise the jaw. To inspect small areas of the bronchi, a fibrobronchoscope is inserted through the instrument tube. At the end of the study, the patient is delivered to the ward for several hours to observe.
After the fibrobronchoscopy, the patient remains in the hospital for another 1 hour. It is undesirable to go home on your own, as the concentration of attention may decrease due to the administered drugs. For the same reason, it is dangerous to get behind the wheel of a car. Smoking, drinking and eating are prohibited for several hours after bronchoscopy in order to avoid bleeding and liquid or food from entering the respiratory tract. After a biopsy, the body’s normal reaction is small bleeding.
For many patients it is important to know how long the procedure lasts. Depending on the objectives of the study, the introduction of the tube takes from 10 to 30-40 minutes. To better understand how bronchoscopy is carried out, a cognitive video clip will help, with a memo about preparation for the procedure, its description and a short demonstration. Watch the video to learn more about the research methodology:
Benefits of the procedure
Endoscopic examination is performed using a flexible or rigid breathing surgical bronchoscope. The choice of instrument depends on the purpose of the bronchoscopy, on the condition of the patient. Flexible bronchoscope is a hollow tube of small diameter, which is equipped with an LED light bulb and an optical system. If necessary, a catheter can be passed through the instrument channel to remove small foreign bodies, administer medications or take a small amount of sputum, wash water, fluids from the bronchi. This method has several advantages:
- The diagnostic procedure allows to identify pathology even in the lower parts of the bronchial tree – this ensures a small diameter of the fibrobronchoscope;
- The risk of damage to the walls of the bronchi, trachea is minimal;
- Does not require general anesthesia.
The rigid instrument procedure is called rigid bronchoscopy. The device consists of several rigid tubes with photo or video equipment, with a light source. Through the bronchoscope can be carried out many tools for medical manipulations, including a catheter.
Advantages of a rigid research method:
- Allows the doctor to make treatment by reorganizing the bronchial tree, administering antibiotics and other medicines directly to the lesions of the bronchi and mucous tissues of the trachea;
- In case of a rigid examination, such manipulations as removal of tumors, improvement of the patency in the bronchi, possible elimination of pathological processes that occurred during the diagnostic examination are possible;
- It is possible to investigate the small bronchi by using a thin catheter;
- Mandatory full anesthesia eliminates the patient’s discomfort during the procedure;
- The rigid bronchoscope is used in emergency resuscitation measures, for suction of liquids for muscovycidosis, bleeding, drowning and other serious conditions.
The absolute contraindications to bronchoscopy are diseases such as respiratory failure 2-3 stages, suffered no more than six months ago, myocardial infarction, acute stage of bronchial asthma, laryngeal stenosis of 2-3 degrees. It is impossible to carry out the procedure with extremely high blood pressure, severe heart rhythm disturbances, schizophrenia and after traumatic brain injuries. Bronchoscopy is contraindicated in case of individual intolerance to painkillers, bronchodilators, sedatives and other drugs required during the study.
There are also relative contraindications to the examination, in which the application of the procedure is possible if the health risk is lower than the need for urgent examination of the trachea and bronchi. Bronchoscopy is usually not performed during pregnancy, an enlarged thyroid gland, diabetes mellitus at a severe stage, during acute lung diseases, during menstruation. It is undesirable to conduct a study for patients suffering from alcoholism. The rigid procedure has the same contraindications as fibrobronchoscopy, however they are supplemented by the following pathologies: diseases of the oral cavity, aortic aneurysm, damage to the cervical spine.
Adverse effects on the body can be associated with different stages of bronchoscopy of the lungs. The development of complications is possible in the presence of allergies or an unexpected reaction to an antibiotic, pain relief, sedatives. If an inadequate amount of anesthesia is administered, the patient may experience severe bronchospasm. There is a risk of bleeding after severe bronchoscopy, and infection is also possible if the procedure was performed without complying with hygiene requirements. The following symptoms may be associated with serious complications:
- Severe chest discomfort, pain;
- Increased body temperature;
- Wheezing in the chest;
- The occurrence of nausea;
- Excretion of large amounts of blood with cough.
Having noticed at least some of these signs, the patient should immediately seek help to check the state of the lungs and relieve possible complications. Other, more rare consequences after the procedure may be hypoxia, arrhythmia, pneumothorax, mediastinal emphysema, bronchospasms.
Bronchoscopy for Tuberculosis
Invasive research in pulmonary tuberculosis in some cases becomes the only way to confirm the diagnosis, but more often it is carried out to clarify and expand the clinical picture of the current disease. TB diseases are often accompanied by such pathologies as COPD, asthma, bronchiectasis, and other chronic processes in the lungs. Manifestations of tuberculosis, including edema, hypoxia, spasms, adversely affect the permeability of the mucous preparations against the disease, prevent the drainage of pus, do not allow pathological formations to dissolve.
Bronchoscopy is a modern diagnostic tool for detecting tuberculosis and controlling the changes that are provoked by the disease. This allows you to prescribe effective treatment regimens and adjust therapy.
Indications for the study of tuberculous disease:
- The inability to take the analysis of sputum material in another way;
- Bleeding and hemoptysis;
- Being in a light cavern, which does not close for a long time;
- Preparation for surgery;
- Incessant and diminishing intense cough;
- Suspicion of a type of tuberculosis that is not susceptible to drugs developed against pathology;
- Serious smoking experience;
- Breakthrough pus;
- Atelectasis of the lung;
During bronchoscopy, it is determined where the pathological process is located, in which part of the trachea or bronchial tree. An assessment of the phase of inflammation, its nature (productive or non-productive) is given, the form is determined – infiltrative or ulcerative. Also, an endoscopist can detect complications – narrowing of the patency in the bronchi, fistulae, dyskinesia. All this is noted in the patient’s card. Manual classification allows the doctor to correctly formulate the diagnosis, which is necessary for the appointment of an individual therapeutic scheme.
In tuberculosis, bronchoscopy plays a therapeutic role. During the procedure, fistulas can be removed, bronchial cleansing of cavey fluids, removal of granulated areas, and bleeding stop. To improve the condition of the patient, a sanitation of the bronchial tree can be carried out as a preventive measure or a curative measure, sometimes medicines against tuberculosis are administered directly with a bronchoscope directly into the affected areas of the respiratory organs.
Features bronchoscopy in children
There are many indications for bronchoscopy in children, but during the procedure a different approach is required than for adults. A child up to 10 years old is being treated with a rigid bronchoscope under general anesthesia. Older children should have a study in a good diagnostic center with a favorable atmosphere. After the procedure, antibiotics must be prescribed, and during bronchoscopy, the doctor must prepare the necessary tools for ventilation of the lungs, as the babies are more likely to have edema and bronchospasms.
The most common indication for an invasive pediatric lungs is a small object or food getting into the bronchi. Foreign bodies without metal parts are not detected by X-ray, therefore bronchoscopy is an important diagnostic method, which allows to identify the location of foreign objects and remove them. Symptoms when inhaled resemble pneumonia. If you do not ensure patency in the bronchi, complications such as suffocation, bronchus suppuration, cessation of breathing with a blocked lungs, air in the pleural cavity may occur.
Indications for bronchoscopy: pulmonary tuberculosis (the study is carried out for biopsy, diagnosis, stop bleeding), bronchi developmental malformation and, as a result, lung atelectasis, unclear origin of lung diseases, muscovicidosis, pulmonary abscess.
Answers to frequently asked questions
- What reveals? Bronchoscopy allows you to get a complete picture of the disease, to identify the presence and extent of the pathological process. An important part of an invasive study is the ability to take a piece of tissue or fluid from lesion foci for analysis for more detailed laboratory examination.
- Does it hurt? During the study, the pain is absent, as local anesthesia is administered or general anesthesia is done. However, there may be unpleasant sensations – nasal congestion, the inability to swallow, in the throat.
- Is there an alternative? An analogue of diagnostic bronchoscopy is a computerized virtual study, but it cannot completely replace the invasive method, since it is impossible to carry out therapeutic manipulations.
- How many times a year can you do? Bronchoscopy should be done only as indicated by the doctor, who will determine the need for re-examination after some time and the duration of the break.
Mikhail, 35 years old: “The doctor prescribed bronchoscopy, as there was a strong cough that was not provoked by any disease. At first I wanted to refuse, according to the patient reviews of bronchoscopy on the forum it was clear that the thing was unpleasant. But prescribed cough drops did not help, he decided. We diagnosed tuberculous lesions, while on the X-ray nothing was visible. I am glad now that conducted the study. Now I continue the treatment, the disease is under control. ”
Tatyana, 29 years old: “I had bronchoscopy for the first and last time more than 5 years ago, I don’t even want to remember this day. During the procedure, contrary to the reassurance of the doctor, I felt pain, in the evening after the study the temperature rose, nauseated. Then we went to the ambulance house, spent several days in the hospital with the strongest infection under antibiotics. Doctors suggested that it was carried during bronchoscopy. My fault – the clinic was unverified, but even in a good hospital I am not ready for it again. ”
Lydia, 32 years: “Somehow a piece of food got into the bronchi! I do not remember what it was – a nut or a seed. Began to cough hard, breathe heavily. While driving to the doctor, it became worse. Immediately appointed bronchoscopy to identify localization and removal. The procedure did not last long, the doctors did everything well, so far they are immensely grateful. Thank God, everything turned out fine! ”