Interventional Bronchoscopy

Abstract

For over 150 years, bronchoscopy, especially flexible bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and therapeutic treatments besides aspiration of airway secretions, however, has been limited. Challenges to the wider use of flexible bronchoscopy have included difficulty in navigating to the lung periphery, the avoidance of vasculature structures when performing diagnostic biopsies and the ability to biopsy a lesion under direct visualization. The last 10-15 years has seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to lung lesions and the ability to visualize lesions during biopsy. Moreover, multiple new techniques have either become recently available, or are currently being investigated to treat a broad range of airway and lung parenchymal diseases such as asthma, emphysema, chronic bronchitis or to alleviate recurrent exacerbations. New bronchoscopic therapies are also being investigated to not only diagnose, but possibly treat malignant peripheral lung nodules. As a result, flexible bronchoscopy is now able to provide a new and expanding armamentarium of diagnostic and therapeutic tools to treat patients with a variety of lung diseases. This state-of-the-art review succinctly reviews these techniques and provides clinicians an organized approach to their role in the diagnosis and treatment of a range of lung diseases.

Modified high-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients undergoing bronchoscopy: a randomized clinical trial

“…Bronchoscopy has an important role in diagnosing and treating respiratory diseases and is now a useful tool to investigate abnormal pulmonary lesions [ 1 ]. Hypoxemia frequently occurs during bronchoscopy [ 2 ]. The partial pressure of arterial oxygen (PaO 2 ) usually decreases by 10–20 mmHg during bronchoscopy [ 3 ], and bronchoalveolar lavage (BAL) is associated with an even greater decrease [ 4 ].…”

Utility of bronchoscopic intra-tumoral alcohol injection to restore airway patency

“…Photodynamic therapy (PDT) can also be used. The choice of therapy is typically dictated by the patient's stability, tumor characteristics, technology availability, clinical expertise, and physician preference (16). Sometimes, a large tumor burden and bleeding tendency makes it difficult to debulk the tumor and relieve the obstruction despite exhaustive multimodality approaches.…”

Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document

“…Radial endoscopic ultrasound (R-EBUS), fluoroscopy, CT, cone beam CT or a combination of R-EBUS and radiology imaging are used to confirm position prior to sampling. [189][190][191][192][193][194][195][196][197][198] A meta-analysis of R-EBUS showed a pooled sensitivity of 0.72 (95% CI 0.70-0.75). 199 Significant study heterogeneity was noted.…”