What Is a Bronchoscopy?

Your Bronchoscopy Procedure and Possible Risks

illustration of the lungs and bronchi
What should you know about your bronchoscopy procedure?. Istockphoto.com/Stock Photo©yodiyim

What is a bronchoscopy, why might this procedure be done, and what can you expect? What are the possible side effects of complications of the procedure?

Bronchoscopy - Definition

A bronchoscopy is a medical procedure during which a narrow tube (a bronchoscope) is inserted through your mouth or nose in order to look inside your large airways. A bronchoscopy may be done to diagnose a condition such as lung cancer, or treat a medical problem such as a foreign object that is lodged in the airways.

When Is a Bronchoscopy Done?

A bronchoscopy is used to evaluate lung symptoms such as a chronic cough, coughing up blood (hemoptysis), or when a lung disease or lung cancer is suspected after an abnormality is seen on x-ray studies.During a bronchoscopy, doctors are able to visualize the inside of the airways and take a biopsy of any areas that appear abnormal, to help diagnose a lung disease or lung cancer. Newer techniques such as endobronchial ultrasound also allow physicians to evaluate tissue in the lungs which is located deeper than the airways.

A bronchoscopy also may be used for treatment. It is sometimes done to stop bleeding in the airways, to place a stent to open constricted airways, to remove foreign objects, or to treat a lung cancer that is present in or near the large airways. An example of the latter is brachytherapy, a treatment in which radiation is delivered directly to a tumor through a bronchoscope.

Types of Bronchoscopy

There are two major types of bronchoscopes that are used during a bronchoscopy, depending upon the condition that is being diagnosed or treated.

Flexible Bronchoscopes
A flexible bronchoscope is a thin flexible lighted tube that is inserted through the nose or mouth to gain access to the airways.

This procedure is used more often than a rigid bronchoscope and does not require a general anesthetic.

Rigid Bronchoscopes
A rigid bronchoscope is a rigid tube approximately one cm in diameter that is inserted in the operating room under general anesthesia. A rigid bronchoscope may be used if you have bleeding in your airways, to place a stent to open constricted airways, or to remove a foreign object.

New Techniques in Bronchoscopy

In addition to its traditional role in allowing the physician to explore your bronchi, newer techniques are allowing doctors to visualize tumors within the lungs which do not extend into the bronchi. One of these techniques known as endobronchial ultrasound. In this procedure, a tumor deep to the airways may be visualized with ultrasound and biopsied during a bronchoscopy (an ultrasound guided needle biopsy).

In addition to techniques designed to look deeper than the airways during a bronchoscopy, there are also several news technologies used to diagnose early lung cancers.

These include autofluorescence bronchoscopy, narrow band imagery, and high magnification video bronchoscopy.

Preparing For Your Bronchoscopy

Before ordering a bronchoscopy, your doctor will talk with you about the risks of the procedure, and what she may expect to find by doing the test. If you are on any medications that can increase bleeding, such as Coumadin (warfarin), aspirin, or anti-inflammatory medicines such as Advil (ibuprofen), she will recommend discontinuing these for a period of time before the test. Make sure to let your doctor know if you are on any herbal medications since some of these can thin your blood as well. Before the procedure, you will be asked to “fast”—that is, not eat or drink anything (even water) for several hours.

During Your Bronchoscopy

A bronchoscopy is usually performed by either a pulmonologist (a lung specialist) or a thoracic surgeon. When you arrive at the hospital, a nurse will ask you several questions and place an IV (intravenous line) in your arm. She will also fit you with monitors so that your blood pressure and heart rate can be checked throughout the procedure. The physician performing the procedure will visit with you to discuss the procedure and its risks, and ask you to sign a consent form. If you are having a rigid bronchoscopy, the anesthesiologist will also talk to you about the anesthesia before you go into the operating room.

During a flexible bronchoscopy, you will be given a medication to make you sleepy (twilight sleep), and a medication to help dry secretions in your lungs. A local anesthetic will be used to numb your throat or nose before the bronchoscope is inserted. This may cause you to cough temporarily. The amount of time the procedure takes can vary, and will depend upon what your doctor sees during the procedure and whether or not a biopsy is done.

With a rigid bronchoscopy, you will be taken to the operating room and given a general anesthetic prior to the procedure.

What Can You Expect After Your Bronchoscopy?

When you are finished with your bronchoscopy, you will be taken to the recovery room where you will be monitored closely for two to four hours. You will feel groggy as the effects of the medications wear off, and it is common for your throat to feel irritated and to be hoarse for some time. You may cough up small amounts of dark brown blood, and this may continue for a day or two. Once you are able to swallow without choking, you will be allowed to eat, beginning with sips of water. Since the effects of the medications can last several hours, you will be asked to bring someone with you who can drive you home.

Possible Complications

Most people tolerate a bronchoscopy quite well with minimal complications. Some possible complications that your doctor may discuss with you include:

  • Bleeding - A small amount of bleeding may occur, especially if a biopsy was taken during the procedure
  • Pneumothorax (a collapsed lung) - If a pneumothorax is small, your doctor may simply follow it with chest x-ray, but if it is large, a chest tube may need to be placed to remove the air.
  • Infection
  • Hoarseness
  • Spasms in the airway such as laryngospasm (spasm of the larynx), or bronchospasm (spasm of the bronchi)
  • Cardiac complications such as an abnormal heart rhythm
  • Complications related to the anesthesia

Your Results

Following your bronchoscopy, your doctor will schedule an appointment to discuss your results. If a biopsy was taken during your procedure, it will take a few days for the lab to evaluate the tissue and send results to your doctor.

If your doctor suspects you may have lung cancer, check out this information on how to  read your lung cancer pathology report.

When to Call Your Doctor

You should call your doctor if you have any symptoms or questions that concern you. Call your doctor right way if you cough up bright red blood (you may have some dark brown blood left from the procedure), develop a fever, or notice any worsening in your breathing.

Sources:

Andolfi, M., Potenza, R., Capozzi, R., Liparulo, V., Puma, F., and K. Yasufuku. The Role of Bronchoscopy in the Diagnosis of Early Lung Cancer: A Review. Journal of Thoracic Disease. 2016. 8(11):3329-3337.

Herth, F. Bronchoscopy/Endobronchial Ultrasound. Frontiers of Radiation Therapy and Oncology. 2010. 42:55-62.

Khan, K., Nardelli, P., Jaegar, A. et al. Navigational Bronchoscopy for Early Lung Cancer: A Road to Therapy. Advances in Therapy. 2016. 33(4):580-96.

Lee, P. et al. Management of complications from diagnostic and interventional bronchoscopy. Respirology. 2009. 14(7):940-53.

Lin, C., and F. Chung. Central Airway Tumors: Interventional Bronchoscopy in Diagnosis and Management. Journal of Thoracic Diseases. 2016. 8(10):E1168-1176.

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