Bronchoscopy

 

The Department of Respiratory medicine includes a bronchoscopy service with expertise in diagnostic and therapeutic bronchoscopy. Routine bronchoscopy lists are Tuesday and Thursday with plans to expand to a daily bronchoscopy list. This is supported by all four consultant respiratory services.

 

What is a bronchoscopy?

A bronchoscopy is procedure where a doctor looks into the main tubes that carry air into your lungs (trachea and bronchi) large airways (the trachea and bronchi). These are the main tubes that carry air into the lungs.

 

Why do I need a bronchoscopy?

This test will allow the doctor to look for signs of lung disease or certain lung conditions.

A rigid bronchoscope can be used to remove objects which have been inhaled, such as peanuts.

 

What happens during a bronchoscopy?

Bronchoscopy using a flexible bronchoscope

This is usually done as an outpatient or day case. The doctor will numb the inside of your nose and the back of your throat by spraying on some local anaesthetic. This may taste a bit unpleasant. Also, you will normally be given a sedative to help you to relax. This is usually given by an injection into a vein in the back of your hand. The sedative can make you drowsy, but it is not a general anaesthetic and does not 'put you to sleep'. However, you are unlikely to remember anything about the bronchoscopy if you have a sedative.

You may be connected to a monitor to check your heart rate and blood pressure during the procedure. A device called a pulse oximeter may also be put on a finger. This does not hurt. It checks the oxygen content of the blood and will indicate if you need extra oxygen during the bronchoscopy. You may have a soft plastic tube placed just inside your nostril to give you oxygen during the procedure. 

The doctor will insert the tip of the bronchoscope into a nostril or your mouth and then gently guide it round the back of your throat into your trachea (windpipe). The bronchoscope is a long, thin, flexible tube, about the width of a thin pencil (see picture). The doctor looks down the bronchoscope and inspects the lining of the trachea and main bronchi (the main airways). Also, modern bronchoscopes transmit pictures through a camera attachment on to a TV monitor for the doctor to look at. The bronchoscope may make you cough.

The doctor may take one or more biopsies of parts of the inside lining of the airways - depending on why the test is done and what they see. This is painless. The biopsy samples are sent to the lab for testing. The bronchoscope is then gently pulled out. 

The bronchoscopy itself usually takes about 20-30 minutes. However, you should allow at least two hours for the whole appointment, to prepare, give time for the sedative to work, for the bronchoscopy itself, and to recover.

 

Bronchoscopy using a rigid bronchoscopy

This requires a general anaesthetic similar to that for minor operations. So, after receiving the anaesthetic, the next thing you know is when you wake up in a recovery room.

 

Endobronchial ultrasound-guided transbronchial biopsy (EBUST-TBNA)

In some cases the doctor may use ultrasound to try and obtain a sample of tissue in lung lesions such as lymph nodes that cannot be seen using bronchoscopy because they do not protrude into the trachea (windpipe) and bronchi. These lung lesions often have no symptoms and the abnormality is detected on chest X-ray or computed tomography (CT) scanning. This procedure is carried out the same as for a flexible bronchoscopy. Images are obtained using the ultrasound probe. The doctor will use these images as a guide when taking samples of the lung lesions.

 

Cryoprobe assisted transbronchial lung biopsy

This technique is used to take lung biopsy specimens often to diagnose the type of pulmonary fibrosis you may have. CUH is the only centre in Ireland providing this service (Dr Henry and Dr Kennedy). You will have to have stopped and anticlotting tablets like aspirin, Plavix or warfarin for at least 5 days before the procedure. You will be having a CXR after the procedure to ensure there is no air leak or pneumothorax after the procedure. The risks of the procedure are bleeding, which is usually minor or pneumothorax. In the event of more significant bleeding or airleak afterwards, you may need to stay in hospital for an extra day or so – risk 10-20%

 

What can I expect after a flexible bronchoscopy/ endobronchial ultrasound-guided transbronchial biopsy?

If you have a sedative you may take an hour or so before you are ready to go home after the test is finished. The sedative will normally make you feel quite pleasant and relaxed. However, you should not drive, operate machinery or drink alcohol for 24 hours after having the sedative. You should not eat or drink anything for two hours after the test because your throat will still be numb. You will need somebody to accompany you home and to stay with you for 24 hours until the effects have fully worn off. Most people feel able to resume normal activities after 24 hours. 

The doctor may tell you what they saw before you leave. However, if you have had a sedative you may not remember afterwards what they said. Therefore, you may wish to have a relative or close friend with you who may be able to remember what was said. The result from any biopsy may take a few days to come back.

 

Are there any side-effects or possible complications?

Most are done without any problem. Your nose and throat may be a little sore for a day or so afterwards. You may feel tired or sleepy for several hours, caused by the sedative. There is a slightly increased risk of developing a throat or chest infection following this procedure. 

If you had a biopsy taken, you may cough up a little blood a few times in the next day or so. Rarely, a bronchoscopy / end bronchial ultrasound-guided transbronchial biopsy can cause damage to the lung. This is more likely to occur if a specialised biopsy of lung tissue is taken. This can sometimes 'collapse' a lung. Serious complications from a bronchoscopy/ End bronchial ultrasound-guided transbronchial biopsy are rare.

 

What preparation do I need to do?

You will usually have a blood test done shortly before the procedure to check how well your blood will clot. This is to make sure that you are not likely to bleed following the procedure. You may be advised not to take any medicines that affect blood clotting such as aspirin, plavix and warfarin for one week before the bronchoscopy/ End bronchial ultrasound-guided transbronchial biopsy. (You may need to discuss your medication with your doctor if you take such medicines for other conditions.)

  • You should not eat or drink for several hours before the bronchoscopy/ End bronchial ultrasound-guided transbronchial biopsy. (Small sips of water may be allowed up to two hours before the test.)
  • Do not wear nail varnish
  • You will need somebody to accompany you home, as you will be drowsy with the sedative.