What is a bronchoscopy?
The term bronchoscopy is made up of the Greek words for airway/air tube (bronchus) and look (skopein). Colloquially, the examination is also known as a lung endoscopy, although it is not possible to examine the entire lung, but only the larger airways.
The bronchoscope is a thin, flexible tube or a rigid tube with a tiny video camera at the front end. It is inserted into the windpipe via the mouth or nose. To enable the doctor to view the structures there without restriction, a light source and often a rinsing and suction device are also attached to the bronchoscope. In addition, special instruments such as forceps or scissors can be inserted into the airways via a working channel of the bronchoscope, allowing small surgical procedures to be carried out during the examination (e.g. taking a tissue sample).
As mentioned, there are two types of bronchoscope. Depending on which one the doctor uses, there are two types of bronchoscopy:
- flexible bronchoscopy: Flexible bronchoscopy is the most common form. The flexible bronchoscope is a soft tube with a small diameter of 2 to 6 mm, so that the risk of injury is very low. A local anesthetic is usually sufficient for this examination.
When is a bronchoscopy performed?
Bronchoscopy is used for both the diagnosis and treatment of lung diseases.
Diagnostic indications
- Pneumonia (inflammation of the lungs)
- Chronic cough of unknown cause
- Clarification and sampling (biopsy) of benign and malignant tumors or other respiratory changes
- Taking tissue swabs with the help of small brushes
- Coughing up blood (hemoptysis)
- Unclear lung changes in the chest X-ray
Therapeutic indications
- Removal of inhaled foreign bodies
- Aspiration of thick mucus
- Lung lavage (bronchoalveolar lavage, BAL) with saline solution (sometimes also used for diagnostic purposes)
- Hemostasis
- Widening of bronchial constrictions with special tubes (stents)
- Insertion of radiating elements (radio-nuclides) for local radiotherapy for lung cancer
What is done during a bronchoscopy?
Before the actual examination, your doctor will ask you about your medical history (anamnesis) and inform you about the possible complications of a bronchoscopy. In addition, a blood count will be taken and a pulmonary function test (lung function test) will be carried out. In some cases, an X-ray examination or computer tomography of the lungs and an ECG may also be necessary.
As the airways have no pain fibers, only the insertion of the bronchoscope through the nose or throat is unpleasant and can trigger a cough. For flexible bronchoscopy, a local anaesthetic and mild sedatives are therefore sufficient. In contrast, a general anesthetic is always required for a rigid bronchoscopy.
The doctor carefully inserts the bronchoscope and inspects the mucous membrane on the way to the bronchi. The airways of the lungs branch out like a tree from the windpipe into the bronchi. As a rule, the doctor examines the branches up to the third or fourth branch. Where necessary, further instruments can now be inserted via the working channel to take samples and perform minor operations. After the procedure, blood residues and secretions are liquefied with physiological saline solution and suctioned out. The doctor then removes the bronchoscope and you are taken to the recovery room for further monitoring.
What are the risks of a bronchoscopy?
There are hardly any risks associated with bronchoscopy. However, the examination is not completely risk-free – complications rarely occur, sometimes even if the examination is carried out carefully:
- Injuries to the airways with penetration of the bronchial wall (perforation)
- Bleeding
- Collapse of one or both lungs (pneumothorax) due to injury to lung tissue
- Oxygen deficiency (hypoxia)
- Cardiac arrhythmia and low blood pressure (hypotension)
- Swelling of the larynx (laryngeal edema) or injuries in the area of the larynx
- Inflammation (in the hours and days following the procedure)
What do I need to consider after a bronchoscopy?
You will remain under medical observation for some time after the bronchoscopy. Due to the anesthetics or anesthetics, you must not eat anything for at least an hour, as you could otherwise choke. In addition, you should not drive or use public transportation for 24 hours, as the after-effects may limit your ability to react. You should therefore arrange for someone to pick you up and take you home.
Your doctor will discuss the examination findings and any follow-up procedures with you. If a tissue sample was taken during the bronchoscopy (biopsy), you will usually receive the results of the examination after two to three days.
