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Bronchoscopy

Purpose of the procedure

A bronchoscopy is a procedure which can help to diagnose, and sometimes to treat,  conditions of the airways and lungs. It is usually performed as an outpatient or day case procedure.

There are a number of reasons why a patient may be offered bronchoscopy at Papworth Hospital.  These may include coughing up blood, a persistent cough or an abnormal chest x-ray.  Bronchoscopy is performed routinely in patients after lung transplantation, and is helpful in the diagnosis of difficult lung infections, inflammatory conditions and tumours in the lung.  Papworth is also a referral centre for more complex bronchoscopic procedures, like endobronchial ultrasound (EBUS), autofluorescence bronchoscopy, airway stenting and bronchoscopic cryosurgery and electrocautery.

Effect on patients

Serious adverse effects from bronchoscopy are exceptionally rare.  As with any medical procedure there may be risks involved, which will depend upon the type of procedure being undertaken.  Your consultant will talk to you about the benefit to you of having a bronchoscopy, any risks involved, and how these relate to your own medical condition and health.  

What happens during the procedure

After you have given informed consent to the procedure, you will be taken to the procedure room.  The clinical staff will  carry out routine checks to make sure that they are planning to do the right procedure on the right person and that anything might affect the procedure (for example, if you are taking warfarin to thin the blood) has been taken account of.  Once everything is prepared, you will be given a sedative injection to make you sleepy, and local anaesthetic to the nose, throat and windpipe.  The bronchoscope is then passed either through the nose or mouth into the air tubes in the lungs.  The bronchoscope allows your consultant to view the airways for any abnormalities such as bleeding, inflammation or tumours.  Small specimens can be taken from the bronchial tubes during the procedure if further examination is required.

In some patients, especially after lung transplantation, it may be necessary to take small samples of lung tissue called transbronchial biopsies.  Your doctor will discuss with you explicitly if this is necessary in your case.  Transbronchial biopsies can be very valuable for diagnosing certain lung conditions but carry a small risk of puncturing the lung in about 1 in 20 patients.


Endobronchial ultrasound (EBUS)
In this procedure a specialised bronchoscope, bearing a small ultrasound machine in its tip, is used.  The ultrasound permits the bronchoscopist to look through the walls of the airways to view lymph glands and blood vessels within the centre of the chest.  Samples can then be taken from the lymph glands for diagnosis.  The bronchoscope is slightly larger than a standard scope and is therefore always passed through the mouth rather than the nose.

Therapeutic bronchoscopy
Bronchoscopy can also be used to provide treatment for certain lung problems, usually in the setting of a cancer in the lungs where the air tubes are being narrowed, making breathing more difficult.  This can happen either because a tumour is squashing the air tube from outside, or because it is growing within the air tube.  Bronchoscopy can be used to relieve any obstruction from the inside.  This can be done either by placing an expanding wire-mesh tube called a stent, to hold open the airway if it is being squashed, or by removing the obstruction like removing a cork from a bottle.  Methods for removing tumour include cryotherapy (freezing), a bit like freezing warts on the skin, or by burning it away using electricity in a procedure called electrocautery.  These procedures may be quite complex and your consultant will explain in detail what is planned if a therapeutic bronchoscopy is recommended in your case.

Autofluorescence bronchoscopy
Autofluorescence bronchoscopy is mainly used within research trials to look for signs of very early pre-cancerous changes in the airways.  The bronchoscope looks exactly the same as a normal flexible bronchoscope but it has special imaging equipment which enables the airways to be viewed with blue light of a certain wavelength.  This shows up abnormalities within the airways that may be invisible under normal white light.  In all other respects the procedure is identical to a normal bronchoscopy.

What to expect afterwards

After the procedure you will be taken to the ward area to rest and wake up.  Most often this will be the thoracic day ward, though if you are already an inpatient you will be returned to your normal ward.  You will probably feel drowsy and may expect gradually to wake up over about an hour, although people vary widely in how quickly they wake up.  If samples have been taken from the lungs, it is likely that if you cough up any phlegm it will be slightly bloodstained.  This is because there is always a little bleeding when specimens are taken.  The bronchoscopist will have made sure, however, that any bleeding has stopped before the end of the procedure, so any blood that you cough up will have already been spilt and will not mean that you are bleeding internally.  About an hour after the end of the procedure, you will be given something to drink.  By this time any numbness in your throat from the local anaesthetic should have fully worn off and you should be able to swallow normally.  If you can drink OK then you will be offered something to eat and allowed home.

Some people have a sore throat for a few days after bronchoscopy.  This will settle down and may be helped by taking paracetamol or gargling with a mouthwash.  About 1 in 10 patients notices a fever about 6-12 hours after the procedure.  This does not mean you are coming down with an infection, and will settle spontaneously.  If you are uncomfortably hot taking 1-2 paracetamol tablets may help.

Certain sampling procedures, such as transbronchial biopsy, carry a small risk of causing a puncture in the lung.  Your doctor will warn you if this applies in your case and you will be checked after the procedure to make sure that no puncture has occurred.  If there is a puncture, it usually requires no specific treatment and gets better by itself, but sometimes it is necessary to insert a tube between the ribs under local anaesthetic to drain away air leaking from the lung until the leak heals up.

Rehabilitation

It is very important that you should not drive, operate any dangerous machinery or enter into any legally binding agreements for 24 hours after your bronchoscopy.  This is because the sedative can slightly affect your judgement and behaviour, even if you are feeling fine in yourself.  You should not attempt to return to work on the day of your bronchoscopy.  If you live alone, we would recommend that you try to have a friend or relative with you in the same house until the following morning.

 

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