Flexible fiberoptic bronchoscopy in respiratory care: Diagnostic yield, complications, and challenges in a Nigerian Tertiary Center

Adewole, Olanisun Olufemi; Onakpoya, Uvie Ufuoma; Ogunrombi, AB; Komolafe, Akinwumi Oluwole; Odeyemi, AD; Adeniran, S; Erhabor, G E

doi:10.4103/1119-3077.180068

Cited by 13 publications

(17 citation statements)

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“…The diagnostic bronchoscopic yield of 49.2% for suspected thoracic malignancy at our institution was similar to other studies. [ 6 , 7 , 10 , 11 ] Consistent with other reports, the diagnostic yield was higher in the presence of endobronchial lesions or performance of EBUS-TBNA [ 8 , 12 , 13 , 14 , 15 ] Our study did not identify any demographic, clinical factors or radiographic findings predictive of a diagnostic or non-diagnostic bronchoscopy. The time frame to establish the diagnosis was variable; the main contributing factors included difficulty in contacting and tracing patients, patients missing follow up appointments, time waiting for additional imaging required prior to scheduling further interventions, waiting time to be seen by other specialist and booking of additional procedures.…”

Section: Discussionsupporting

confidence: 90%

Outcomes of patients with a non-diagnostic initial bronchoscopy for suspected thoracic malignancy

et al. 2020

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Lung cancer is 1 of the leading causes of cancer-related deaths and bronchoscopy is an essential tool for the diagnosis. The diagnostic yield varies based on the characteristics of the lesion and bronchoscopic techniques employed. There is limited data regarding outcomes of patients suspected of thoracic malignancies with a non-diagnostic initial bronchoscopy. The goal of the study was to evaluate the outcomes of patients with a non-diagnostic bronchoscopy for suspected thoracic malignancies and to evaluate variables predictive of a diagnostic bronchoscopy. Retrospective analysis of adult patients at BronxCare Hospital Center who underwent bronchoscopy for suspected thoracic malignancy. The study period was January 2012 to February 2019. Exclusion criteria included patients who underwent only inspection bronchoscopy or bronchoalveolar lavage as the diagnostic yield for malignancy with these techniques is low. All other bronchoscopic procedures were included that is, endobronchial biopsies, transbronchial biopsies, and endobronchial ultrasound guided-transbronchial needle aspiration. Bronchoscopy was considered diagnostic when a specific histopathological diagnosis was established. 311 patients underwent bronchoscopy to rule out malignancy. A diagnosis was obtained in 153 (49.2%) patients, 81 (52.9%) had primary lung cancer and 14 (9.15%) other malignancies. 158 (50.8%) patients had initial non-diagnostic bronchoscopy; 86 (54.43%) were lost to follow up. Of the remaining 72 (45.57%) patients, radiological resolution or stability was observed in 51 (70.8%) patients. Primary lung cancer was found in 13 (18.05%) patients and other malignancies in 5 (6.94%). Predictive of a diagnostic bronchoscopy was the performance of endobronchial biopsies and endobronchial ultrasound guided-transbronchial needle aspiration. This study highlights some of the barriers to the timely diagnosis of thoracic malignancies. Following patients with a non-diagnostic procedure as well as all those patients with diagnosed malignancies it of the utmost importance. In patients available for follow up, close to 25% of additional cases with treatable malignancy could be identified and patients diagnosed with cancer could receive timely treatment.

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Section: Discussionsupporting

confidence: 90%

Outcomes of patients with a non-diagnostic initial bronchoscopy for suspected thoracic malignancy

et al. 2020

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“…Bronchoscopy is considered a low-risk, high-yield procedure with an overall low complication rate, which ranges from 1% to 35%. [5,26,27,28] We noted a higher incidence of bleeding compared with other studies, this may be due to overreporting as it is difficult to exactly quantify of bleeding when diluted with saline and body fluids. Incidence of pneumothorax was similar to published data.…”

Section: Discussionmentioning

confidence: 55%

“…The diagnostic yield of bronchoscopies at our institution was 51%, consistent with other studies. [4,5,16,17] Our study did not identify any demographic or clinical factors predictive of a diagnostic bronchoscopy. Presence of bilateral diffuse infiltrates on chest imaging was associated with a lower diagnostic yield.…”

Section: Discussionmentioning

confidence: 76%

“…[1–3] Several studies have evaluated the diagnostic yield of FFB for different clinical conditions, including the presence of masses or nodules and diffuse lung diseases, and in immunocompromised patients, among others; however, none has examined the relationship between the clinical and radiological predictors and outcomes of a non-diagnostic bronchoscopy. [4,5] Confounding factors that impact the interpretation of these studies include the different methodologies and techniques used during bronchoscopy and lack of consensus on the definition of a “diagnostic” bronchoscopy, especially for those patients where the tissue biopsy does not indicate a specific diagnosis. Data regarding outcomes of patients considered to have a non-diagnostic bronchoscopy remain sparse.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of patients with non-diagnostic bronchoscopy

Venkatram

Pena²,

Bajantri³

et al. 2019

Medicine

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Bronchoscopy is one of the most common diagnostic procedures in pulmonary practice. Data on the outcome of patients following a non-diagnostic bronchoscopy are sparse. Diagnostic yield depends on indication, the characteristics of patients, and the chest imaging. The aim of this study was to evaluate the outcomes of patients with a non-diagnostic bronchoscopy and to compare patients who had a diagnostic with those that had a non-diagnostic bronchoscopy. Retrospective, single-center study of adult patients who underwent bronchoscopy with transbronchial biopsy (TBBX) and/or endobronchial biopsy (EBBX), endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), or brushing. A strict definition for a “diagnostic” bronchoscopy was used. Univariate and multivariate analyses were performed. A total of 684 patients were identified, 350 (51%) had a diagnostic procedure. Of the 334 patients with a non-diagnostic bronchoscopy, 196 (58.6%) were followed, but only 172 (88%) completed 1 year of follow-up. Most of the patients (57.8%) had resolution or stabilization of the condition; in the remaining patients, malignancy was most commonly diagnosed after further investigation followed by diffuse lung diseases and infections. Pulmonary tuberculosis was diagnosed in 8 patients. EBUS-TBNA and EBBX were the procedures associated with a diagnostic bronchoscopy. Presence of bilateral interstitial infiltrates predicted a non-diagnostic bronchoscopy. A significant number of patients with non-diagnostic bronchoscopy may have serious treatable disease that is identified upon further investigation. Close follow up of patients with a non-diagnostic procedure is warranted. Our study found no clear clinical or radiological predictors of diagnostic bronchoscopy.

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“…1 Nasal and oral insertion are the two most common approaches in clinical practice, with nasal insertion being preferred due to its advantages with respect to its simplicity, time-saving nature, and fewer complications. 2 Topical lidocaine administered through the bronchoscope is better-tolerated with fewer complications, which contributes to the widespread use of topical anesthesia during exible bronchoscopy. [3][4][5] Although there have been several measures for improving patient comfort during the exible bronchoscopy procedure, the relatively narrow nasal cavity and fragile nasal mucosa impede insertion, and a quick and blind removal may be necessary.…”

Section: Introductionmentioning

confidence: 99%

Nasal Probe Tests Decreased the Procedure Time During Flexible Bronchoscopy: A Randomized Controlled Trial

Zhu¹,

Zhang²,

Shi³

et al. 2020

Preprint

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Background: Nasal insertion is the preferred method in flexible bronchoscopy; however, the relatively narrow nasal cavity increases the difficulty of bronchoscope insertion. The aim of the study was to investigate the advantages of a prior nasal cavity probe during flexible bronchoscopy and to investigate whether this novel method could reduce the complications associated with flexible bronchoscopy.Methods: This prospective randomized controlled trial was conducted in a tertiary hospital between May 2020 and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: a control group, a simple cotton bud detection group (CD group), and an adrenaline detection group (AD group). The outcomes were the time to pass the glottis, the first-pass intubation success rate, and postoperative complications, especially nasal bleeding.Results: In total, 189 men and 111 women were enrolled in the study, with a mean age of 55.69 ± 12.86 years. The operation time was longer in the control group (24 [14.25-45.75] s) than in the CD group (19.5 [12.25-32.75] s). Compared with that in the CD group, the first-pass intubation success rate was significantly lower in the control group (p<0.05). There was no difference in nasal bleeding between the control group and the CD group (p=0.506). Nasal bleeding after flexible bronchoscopy was more common in the CD group than in the AD group (p=0.005); however, there was no significant between-group difference in hemostatic use (p=0.245). Conclusions: Use of a prior nasal cavity probe during flexible bronchoscopy can significantly reduce the time to pass the nasal cavity, improve the first-pass intubation success rate, and reduce postoperative nasal bleeding. Nasal detection is recommended as a time-saving procedure for patients undergoing flexible bronchoscopy. Trial registration: ChiCTR2000032668, 6th May.2020.

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Flexible fiberoptic bronchoscopy in respiratory care: Diagnostic yield, complications, and challenges in a Nigerian Tertiary Center

Abstract: These results show that FOB is a useful and safe procedure with a low complication rate in our setting.

Cited by 13 publications

References 1 publication

Outcomes of patients with a non-diagnostic initial bronchoscopy for suspected thoracic malignancy

Outcomes of patients with a non-diagnostic initial bronchoscopy for suspected thoracic malignancy

Outcomes of patients with non-diagnostic bronchoscopy

Nasal Probe Tests Decreased the Procedure Time During Flexible Bronchoscopy: A Randomized Controlled Trial

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