Bronchoscopy

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Test Overview

Bronchoscopy is a procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope. During a bronchoscopy, your doctor will examine your throat, larynx, trachea, and lower airways.

Bronchoscopy may be done to diagnose problems with the airway, the lungs, or with the lymph nodes in the chest, or to treat problems such as an object or growth in the airway.

There are two types of bronchoscopy.

• Flexible bronchoscopy uses a long, thin, lighted tube to look at your airway. The flexible bronchoscope is used more often than the rigid bronchoscope because it usually does not require general anesthesia, is more comfortable for the person, and offers a better view of the smaller airways. It also allows the doctor to remove small samples of tissue (biopsy).
• Rigid bronchoscopy is usually done with general anesthesia and uses a straight, hollow metal tube. It is used:
  • When there is bleeding in the airway that could block the flexible scope's view.
  • To remove large tissue samples for biopsy.
  • To clear the airway of objects (such as a piece of food) that cannot be removed using a flexible bronchoscope.

Special procedures, such as widening (dilating) the airway or destroying a growth using a laser, are usually done with a rigid bronchoscope.

Why It Is Done

Bronchoscopy may be used to:

• Find the cause of airway problems, such as bleeding, trouble breathing, or a long-term (chronic) cough.
• Take tissue samples when other tests, such as a chest X-ray or CT scan, show problems with the lung or with lymph nodes in the chest.
• Diagnose lung diseases by collecting tissue or mucus (sputum) samples for examination.
• Diagnose and determine the extent of lung cancer.
• Remove objects blocking the airway.
• Check and treat growths in the airway.
• Control bleeding.
• Treat areas of the airway that have narrowed and are causing problems.
• Treat cancer of the airway using radioactive materials (brachytherapy).

How To Prepare

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the procedure, its risks, how it will be done, or what the results will mean. To help you understand the importance of this procedure, fill out the medical procedure information form(What is a PDF document?).

Before you have a bronchoscopy, tell your doctor if you:

• Are taking any medicines.
• Are allergic to any medicines, including anesthetics.
• Have had bleeding problems or take blood-thinners, such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin).
• Are or might be pregnant.

Your doctor will tell you how soon before the biopsy to stop eating and drinking. Follow the instructions exactly about when to stop eating and drinking, or your test may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.

Your doctor may order other tests before your bronchoscopy, such as a complete blood count (CBC), clotting factors, arterial blood gas (ABG), or lung function tests.

Arrange to have someone drive you home after the procedure.

How It Is Done

You may be asked to remove dentures, eyeglasses or contact lenses, hearing aids, wigs, makeup, and jewelry before the bronchoscopy procedure. You will empty your bladder before the procedure. You will need to take off all or most of your clothes (you may be allowed to keep on your underwear if it does not interfere with the procedure). You will be given a cloth or paper covering to use during the procedure.

The procedure is done by a pulmonologist and an assistant. Your heart rate, blood pressure, and oxygen level will be checked during the procedure.

A chest X-ray may be done before and after the bronchoscopy.

Flexible bronchoscopy

During this procedure, you will lie on your back on a table with your shoulders and neck supported by a pillow, or you will recline in a chair that resembles a dentist's chair. Sometimes the procedure is done while you are sitting upright.

You will be given a sedative to help you relax. You may have an intravenous line (IV) placed in a vein. You will remain awake but sleepy during the procedure.

Before the procedure, your doctor usually sprays a local anesthetic into your nose and mouth. This numbs your throat and reduces your gag reflex during the procedure. If the bronchoscope is to be inserted through your nose, your doctor may also place an anesthetic ointment in your nose to numb your nasal passages.

Your doctor gently and slowly inserts the thin bronchoscope through your mouth (or nose) and advances it to the vocal cords. Then more anesthetic is sprayed through the bronchoscope to numb the vocal cords. You may be asked to take a deep breath so the scope can pass your vocal cords. It is important to avoid trying to talk while the bronchoscope is in your airway.

An X-ray machine (fluoroscope) may be placed above you to provide a picture that helps your doctor see any devices, such as forceps to collect a biopsy sample, that are being moved into your lung. The bronchoscope is then moved down your larger breathing tubes (bronchi) to examine the lower airways.

If your doctor collects sputum or tissue samples for biopsy, a tiny biopsy tool or brush will be used through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab to be studied.

Finally, small biopsy forceps may be used to remove a sample of lung tissue. This is called a transbronchial biopsy.

Rigid bronchoscopy

This procedure is usually performed under general anesthesia. You will lie on your back on a table with your shoulders and neck supported by a pillow.

You will be given a sedative to help you relax. You will have an intravenous line (IV) placed in a vein. Once you are asleep, your head will be carefully positioned with your neck extended. A tube (endotracheal) will be placed in your windpipe (trachea) and a machine will help you breathe. Your doctor then slowly and gently inserts the bronchoscope through your mouth and into your windpipe.

If your doctor collects sputum or tissue samples for biopsy, a tiny biopsy tool or a brush will be inserted through the scope. A salt (saline) fluid may be used to wash your airway, then the samples are collected and sent to the lab for biopsy.

Recovery after bronchoscopy

Bronchoscopy by either procedure usually takes about 30 to 60 minutes. You will be in recovery for 1 to 3 hours after the procedure. Following the procedure:

• Do not eat or drink anything for 1 to 2 hours, until you are able to swallow without choking. After that, you may resume your normal diet, starting with sips of water.
• Spit out your saliva until you are able to swallow without choking.
• Do not drive for at least 8 hours after the procedure.
• Do not smoke for at least 24 hours.

How It Feels

If you have general anesthesia, you will feel nothing during the procedure. Oxygen is usually given through a small tube placed in your nose if you are awake during the procedure.

You may be able to feel pressure in your airway as the bronchoscope is moved from place to place. You may gag or cough during bronchoscopy. Your airway will not be blocked, but if you feel discomfort let your doctor know.

After the procedure, you may feel tired for a day or so and have general muscle aches. If a local anesthetic is used, you may have a bitter taste in your mouth. Your mouth may feel very dry for several hours after the procedure. You may also have a sore throat and some hoarseness for a few days. Sucking on throat lozenges or gargling with warm salt water may help soothe your sore throat.

The anesthesia will make it hard to swallow. You will need to avoid eating or drinking for 1 to 2 hours after the procedure.

If a biopsy sample was taken, it is normal to spit up a small amount of blood after the procedure.

Risks

Bronchoscopy is generally a safe procedure. Although complications are rare, your doctor will discuss any risks with you. Complications that may occur include:

• Spasms of the bronchial tubes, which can impair breathing.
• Irregular heart rhythms (arrhythmias).
• Infections, such as pneumonia. These can usually can be treated with antibiotics.
• Ongoing hoarseness.

If a biopsy was done during bronchoscopy, complications that may occur include:

• A tear in the lung from the biopsy forceps used to collect a tissue sample. This will allow air to flow into the pleural space, producing a partial collapse of the lung (pneumothorax).
• Bleeding caused by the biopsy forceps used to collect the tissue.
• An infection from the biopsy procedure.
• A very small chance of death.

After the procedure

Call your doctor immediately if you:

• Cough up more than 2 Tbsp (30 mL) of blood.
• Have trouble breathing.
• Have a fever for more than 24 hours. A mild fever [lower than 100°F (38°C)] may be present right after the procedure, but this is not a concern.

Results

Bronchoscopy is a procedure that allows your doctor to look at your airway through a thin viewing instrument called a bronchoscope. Your doctor may discuss your results with you soon after the procedure. Test results on any biopsy samples are usually available in 2 to 4 days.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

• A problem that limits your ability to extend your neck.
• A biopsy sample that is too small for a diagnosis.

Also, a biopsy collects tissue from such a small area, so there is a chance that a cancer may be missed.

What To Think About

• Before a final diagnosis is made, the results of a bronchoscopy will be considered along with your medical history, physical examination, and the results of other tests including a chest X-ray or a computed tomography (CT) scan. A lung biopsy may be needed when all of these other results are inconclusive.
  • Chest X-Ray
  • CT Scan of the Body
  • Lung Biopsy
• A needle biopsy with a CT scan is commonly used because it can diagnose many lung problems. A bronchoscopy may be a better option when the problem is close to the airway. Your doctor will determine the best method for you.
• Virtual bronchoscopy uses a CT scan to provide a picture of the throat and airways. It does not require the placement of a bronchoscope down the throat.
• Bronchoscopy methods that use ultrasound and other technologies can help diagnose and treat more problems than standard bronchoscopy. But these methods may not be available everywhere.

References

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