Flexible Bronchoscopy with Multiple Modalities for Foreign Body Removal in Adults

Abstract

ObjectivesAspiration of the lower airways due to foreign body is rare in adults. This study aimed to determine the outcome of patients who received flexible bronchoscopy with different modalities for foreign body removal in the lower airways.Patients and MethodsBetween January 2003 and January 2014, 94 patients diagnosed with foreign body in the lower airways underwent flexible bronchoscopy with different modalities, which included forceps, loop, basket, knife, electromagnet, and cryotherapy. The clinical presentation, foreign body location and characteristics, and applications of flexible bronchoscopy were analyzed.ResultsForty (43%) patients had acute aspiration, which developed within one week of foreign body entry and 54 (57%) had chronic aspiration. The most common foreign bodies were teeth or bone. More patients with chronic aspiration than those with acute aspiration were referred from the out-patient clinic (48% vs. 28%), but more patients with acute aspiration were referred from the emergency room (35% vs. 6%) and intensive care unit (18% vs. 2%). Flexible bronchoscopy with different modalities was used to remove the foreign bodies (85/94, 90%). Electromagnet or cryotherapy was used in nine patients to eliminate the surrounding granulation tissue before foreign body removal. In the nine patients with failed flexible bronchoscopy, eight underwent rigid bronchoscopy instead and one had right lower lung lobectomy for lung abscess.ConclusionsFlexible bronchoscopy with multiple modalities is effective for diagnosing and removing foreign bodies in the lower respiratory airways in adults, with a high success rate (90%) and no difference between acute and chronic aspirations.

Mini grasping basket forceps for endobronchial foreign body removal in pediatric patients

“…Several instruments and modalities have been reported in foreign body removal in combination with flexible bronchoscopy. These include forceps of various shapes, baskets, snaring wire, coagulation knives, and probes for cryotherapy . In pediatric patients, the line‐up of instruments is particularly limited due to the thinner instrument channel of thin bronchoscopes.…”

“…These include forceps of various shapes, baskets, snaring wire, coagulation knives, and probes for cryotherapy. 3 In pediatric patients, the line-up of instruments is particularly limited due to the thinner instrument channel of thin bronchoscopes. We previously used biopsy forceps in pediatric patients, but found that it was often difficult to grasp smooth materials such as beans, and that the foreign body could easily slip free when passing the vocal cords.…”

Accidental aspiration of endodontic file: a dreaded but a preventable complication

“…Although the supine position seems more susceptible to accidental aspiration/ingestion of foreign bodies. 21 In a review done by Ahmed et al a preferential lodgement of FBs was found in the left bronchus than the right with 22.9% and 17.1%, respectively. The right main bronchus is commoner in the erect position and right lateral position while FBs which are small enough preferentially lodge in the left main bronchus in the left lateral position 13 .…”

Foreign body removal in children: Recommendations versus real life—A survey of current clinical management in Germany

“…As a matter of principle, foreign body extraction is a procedure with a considerable complication rate. In contrast to the described task forces, there are a growing number of published clinical reports, discussing and recommending flexible bronchoscopy for foreign body removal in children . Swanson et al retrospectively reported a group of 40 children with foreign body aspiration: 60% of foreign bodies were successfully removed by flexible bronchoscopy alone.…”

“…Task forces of the European Respiratory Society (ERS, 2003) and the American Thoracic Society (ATS, 2015) both recommend rigid bronchoscopy for foreign body removal in children . In contrast to these recommendations, there is an increasing number of publications reporting on, or even propagating, flexible bronchoscopy as primary method for foreign body removal in children …”