Bronchoscopy is an endoscopy method used under local anesthesia or sedation, passing through the patient's nose or mouth, examining the airways and lungs after the larynx, and performing some procedures and interventions for diagnosis and treatment.

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Endo means inside, and scope means looking, seeing, that is, looking inside the body. Bronchoscopy means looking inside the airways. During this procedure, the anatomy of the bronchial tree is examined, and many diseases, especially lung cancer, can be diagnosed. We use the most flexible bronchoscopes.
The image of the airways appears on the monitor with the help of the lens located at the end of the device.

We perform bronchoscopy for three primary purposes.

  1. Diagnostic bronchoscopy
  2. Staging
  3. Therapeutic bronchoscopy.
Bronkoskopi nedir
Figure1 1: Flexible Bronchoscopy (FOB)

Who Needs Bronchoscopy? (Bronchoscopy Indications)

1. Diagnostic
Evaluation of the patient's complaints, symptoms such as:

  • Hoarseness (in the presence of hoarseness, which is not directly considered a disease of the vocal cords by the ENT specialist)
  • A chronic and persistent cough (unexplained cough lasting more than three weeks that is resistant to treatment)
  • Bloody sputum or coughing up blood
  • Wheezing
  • Evaluation of intrabronchial disease (tumor, foreign body, stenosis, fistula, mucus plug, thermal damage)
  • Evaluation of abnormalities in chest X-ray and thorax CT (mass, infiltration, atelectasis, fluid accumulation in the lung)
  • Evaluation of hilar and mediastinal lymph nodes by endobronchial ultrasound
  • Chest traumas and injuries

2. Follow-up purposes

  • Lung cancer staging

3. Therapeutic/interventional

  • For clearing excessive secretion accumulation in the bronchi
  • Removal of foreign bodies (such as turban needle, chickpea, peanut)
  • For the removal of benign or malignant tumors originating from the central bronchi, which cause extreme shortness of breath and suffocation in the patient, with interventional bronchoscopy, namely laser, argon plasma cautery, electrocautery, cryocautery.

4. For research purposes

  • Bronchoalveolar lavage (BAL) application in diffuse lung diseases
  • Biopsy and brushing in asthma

FOB diagnosis rate:

  • It has a high diagnostic value of 85-95% in tumors of the central airways.
  • This rate decreases to 40-60% in peripherally located lung carcinomas.
  • The diagnostic value is around 30% in peripheral tumors smaller than 3 cm.
  • This method, which has a very low complication rate, can also diagnose other lung diseases.
  • The mean diagnostic value of diagnostic bronchoscopy varies between 55-75%.

Absolute contraindications for bronchoscopy:

  • If PaO2 < 60 mmHg after 100% O2 administration – Type II respiratory failure.
  • Severe bronchospasm
  • Unstable asthma.

Partial contraindications for bronchoscopy:

  • Cardiovascular diseases (MI within six months, stable angina, arrhythmia, hypertension)
  • Presence of cerebrovascular pathology
  • High Intracranial pressure
  • Convulsion
  • Bleeding diathesis
  • Thrombocytopenia (<20,000/mm3 for BAL, <50,000/mm3 for biopsy)
  • Platelet dysfunction
  • Severe anemia
  • Portal hypertension
  • Uremia

Types of Bronchoscopy:
Flexible Fiberoptic Bronchoscopy (FOB)
Super dimensional bronchoscopy:
There is a possibility of diagnosis in more peripheral lesions. There is an ultrasound on the bronchoscopy tip.
Autofluorescent bronchoscopy (OFB):
With this method, an early cancer diagnosis is made. We can demonstrate Intrabronchial mucosal abnormalities such as dysplasia, carcinoma in situ (CIS), and early invasive cancers.
Autofluorescent bronchoscopy is a diagnostic method used to evaluate typical/pathological tissue fluorescence characteristics observed under blue light to reveal mucosal abnormalities of the tracheobronchial tree. Normal tissue is green in color, and pathological tissue produces red/brown fluorescence (reflection of light).
The most important indication for this method is the differentiation of normal tissue from premalignant or malignant bronchial mucosa.

EBUS Bronkoskopi
Figure 2: Endobronchial ultrasonography (EBUS)

Endobronchial ultrasonography (EBUS)
We explained this in detail in another section.
The EBUS device combines a bendable bronchoscope and an ultrasonography probe. The ultrasonography probe can be fixed to the tip of the bronchoscope or can be used by sending it through the channel of the bronchoscope into the bronchi. It is used in diagnosing and staging diseases related to the inside of the bronchial tree and conditions in the middle part of the chest, which we call the mediastinum outside the bronchial tree, and in the diseases at the extreme points of the lung.
Its main indications are staging of lung cancer (regional lymph node involvement and extent), guidance for transbronchial needle aspiration, tumoral invasion, and differentiation of vascular structures.

Rigid Bronchoscopy:
It does not stretch, and its diameter is large, so it cannot go deeper; that is, it does not allow segmental examination.
It is done under general anesthesia.
It is preferred in conditions such as:
Endobronchial mass biopsy
In lesions with a high risk of bleeding (such as carcinoids)
Massive hemoptysis (too much blood in the mouth)
Foreign body removal (Foreign bodies such as peanuts, chickpeas, shells, and pins)
Strictures of the trachea
Mechanical dilation to ensure the expansion of the bronchus in stenosis of the trachea

Preparation of the patient before bronchoscopy

Bronchoscopy can be performed under local anesthesia and sedation or general anesthesia, depending on the interventions, the disease, and the patient's condition. We Suppress the cough and gag reflex of the patient with a spray in the mouth and throat of the patient with local anesthesia. We eliminate the feeling of nausea that will occur when the endoscope enters through the mouth.

The flexible bronchoscopy procedure takes an average of 10-12 minutes. After the process, the patient can be discharged. Since the mouth and throat are numb after the procedure, the patient should not eat or drink for 2 hours.

Oral anticoagulants should be discontinued three days before the procedure if a biopsy is planned for bronchoscopy. In rare cases where it is necessary to continue anticoagulants, the INR should be below 2.5, and heparin should be administered. Platelet count, prothrombin time, and partial thromboplastin time should be checked before the transbronchial biopsy.
The patient can eat and drink water after the bronchoscopy.