Bronchoscopy

Bronchoscopy is a technique for visualizing the lower airways using a flexible or rigid bronchoscope, which can be used for diagnostic or therapeutic purposes.

This technique is used for the examination of the airway, among other purposes, for the diagnosis of inflammatory, infectious, tumor, and hemorrhagic processes and the location of foreign bodies.

History

A German, Gustav Killian, performed the first bronchoscopy in 1897. Killian used a rigid bronchoscope to remove a pig bone, performing the procedure under local anesthesia with cocaine In the 1920s Nathan Faux perfected the bronchoscope, using a tube rigid to visualize the trachea and main bronchi. The Japanese, Shigeto Ikeda, invented the flexible bronchoscope in 1966. Initially it used fiber optic filaments requiring an external light source, had an outer diameter of approximately 5 to 6 mm, with the ability to flex 180 degrees and extend 120 degrees, allowing enter the lobar and segmental bronchi. More recently, these original devices have been replaced by bronchoscopes equipped with a video device located at their distal end.

Types

There are two types of bronchoscopes: flexible (fiberbronchoscopy) and rigid. Fiberoptic bronchoscopy is generally performed under local anesthesia, with the patient awake. Rigid bronchoscopy can be used for foreign body removal or stent placement; this procedure is usually performed under general anesthesia.

Purposes of bronchoscopy

Diagnosis

• To observe abnormalities in the airway.
• To obtain samples of pulmonary tissue in several diseases, which can be obtained by performing a biopsy, broncoalveolar washing, or endobronchial brushing.
• To diagnose a patient with lung bleeding, suspected lung cancer, chronic cough, and sarcoidosis, among others.

Therapeutics

• To remove secretions, blood or foreign objects hosted on the airway.
• Resection by laser, electrosurgery or cryotherapy of tumors or stenosis of benign origin of the trachea and bronchus.
• Stent insertion in order to relieve the extrinsic pressure caused by benign or malignant processes.
• Bronchoscopy is also used in percutaneous tracheostomy.
• Tracheal intubation of patients with difficult airway, using a flexible bronchoscope.