Bronchoscopy
Techniques in Bronchoscopy Daniela Gompelmann, Felix JF Herth and Ralf Eberhardt Pneumology and Respiratory Care Medicine, Thoraxklinik, University of Heidelberg
Abstract
Bronchoscopy is the most important tool in diagnosing respiratory disorders. Diagnostic indications are numerous and range from bronchial wash or bronchoalveolar lavage, in case of pulmonary infiltrations, to transbronchial lung biopsies in peripheral solitary pulmonary nodules. Different techniques, such as peripheral endobronchial ultrasound probes, or different navigation systems facilitate diagnosis of peripheral pulmonary lesions. Furthermore, endobronchial-guided transbronchial needle aspiration gained increased significance for mediastinal staging in lung cancer patients. Bronchoscopy also offers many therapeutic modalities. In case of haemoptysis, cold saline lavage, instillation of topical vasoconstrictive agents, endobronchial airway blockade, laser therapy, argon plasma coagulation and electrocautery present useful tools. Another indication for therapeutic bronchoscopy is a central airway obstruction resulting from benign or malignant processes. Rapid symptom control can be achieved by laser-assisted resection, electrocautery and cryodebridement. Furthermore, the insertion of an airway stent re-establishes the patency of obstructed airways. Brachytherapy is another treatment option for malignant airway stenoses. Due to its delayed effects, brachytherapy should only be considered in respiratorily stable patients. Recently developed therapeutic modalities are endoscopic lung volume reduction in patients with chronic obstructive pulmonary disease and bronchial thermoplasty in patients with asthma.
Keywords Techniques, bronchoscopy, bronchoalveolar lavage, respiratory disorders, lung biopsy, brachytherapy
Disclosure: The authors have no conflicts of interest to declare. Received: 10 August 2011 Accepted: 25 August 2011 Citation: European Respiratory Disease, 2011;7(2):137–44 Correspondence: Daniela Gompelmann, Pneumology and Respiratory Care Medicine, Thoraxklinik Heidelberg, Amalienstrasse 5, 69126 Heidelberg, Germany. E:
daniela.gompelmann@thoraxklinik-heidelberg.de
Nowadays, bronchoscopy is a routinely performed technique in pneumology for diagnostic and therapeutic purposes, but it looks back on a long history. Already in the 1890s, the first laryngeal intubations were made accidentally while performing oesophagoscopy.1
In 1894, the
internist Kirstein started to intubate the larynx intentionally and reported about his experiences at a congress of the Southern German Laryngologists in Heidelberg. Gustav Killian, a young ear, nose and throat surgeon, attended his lectures and began himself to develop this technique by performing laryngeal intubation and advancing its scope down to the lobar level.
Therefore, he was interested in advancing imaging and bronchoscopic techniques and asked Machida Endoscope Company and Olympus Optical Company to produce bronchofibrescopes. In 1966, the first flexible bronchoscopes were developed, providing entry to subsegmental bronchi.
In the following years, technology advanced and a modern rigid bronchoscope was developed. In the 1960s, flexible bronchoscopy was introduced by Shigeto Ikeda, a thoracic surgeon who suffered himself from tuberculosis and was involved in the care of tuberculosis patients.3
In 1897, he removed an aspirated piece of pork bone from the right main bronchus of a farmer by using a rigid oesophagoscope. By publishing this experience via his assistant Kollofrath, the idea of bronchoscopy was born.2
Over the last decades, technology has improved and bronchoscopy has become the most important tool in diagnosing respiratory
© TOUCH BRIEFINGS 2011
disorders, but it also offers therapeutic options in various lung diseases. In the European Respiratory Society/American Thoracic Society (ERS/ATS) statement on interventional pulmonology,4
as
well as in the Interventional Pulmonary Procedures guidelines from the American College of Chest Physicians (ACCP),5
the field of
interventional pulmonology, necessary equipment and personnel, indications, contraindications, risks and training requirements for most of the various bronchoscopic procedures are defined. In the present section, the most commonly used bronchoscopic techniques are described.
Two Different Techniques of Bronchoscopy Rigid Bronchoscopy
Today, rigid bronchoscopy is still performed, especially for interventional procedures. This technique requires general anaesthesia, whereas the ventilation is maintained by high-jet-frequency ventilation through the rigid tube.
Different rigid bronchoscopes with various diameters and lengths are available. Some special rigid bronchoscopes also allow viewing at lateral and oblique angles.6
Various instruments for diagnostic or
therapeutic procedures can be inserted through the rigid bronchoscope. The rigid technique can also be combined with the flexible technique, whereby a flexible bronchoscope is passed through a rigid bronchoscope, thus providing inspection of, and intervention in, the distal airways.3,6
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