Thin Bronchoscope for Evaluating Stenotic Airways during Stenting Procedures

Abstract

Background: Flexible bronchoscopy can play an important role in the evaluation of an airway lumen during therapeutic bronchoscopic procedures. Despite its potential usefulness, however, evaluation with a standard-sized bronchoscope, which cannot pass completely through a severely stenosed airway, is often unsatisfactory. Objectives: This study aimed to evaluate the usefulness of prototype thin bronchoscopes for assessing stenotic airways during stenting procedures. Methods: Forty-six patients with central airway stenosis requiring stent implantation were enrolled in this prospective study. After inserting a rigid bronchoscope under general anesthesia, a flexible bronchoscopic evaluation using a 5.9- or 6.0-mm standard bronchoscope was performed, followed by evaluation using a prototype 3.4- or 3.5-mm thin bronchoscope for airways beyond the site of stenosis, which could not be visualized by the standard bronchoscope. Results: A standard bronchoscope could not pass through the stenotic airway in 15 of 46 patients (33%). On univariate analysis, the grade of stenosis (p < 0.001), the presence or absence of atelectasis (p = 0.04) and the presence or absence of viscous secretions (p = 0.02) were related to the rate of successful passage by a standard bronchoscope. On multivariate analysis, only the grade of stenosis remained independently associated with the success rate. In 12 of the 15 patients (80%), the airway lumen beyond the stenotic lesion, which could not be reached by a standard bronchoscope, was successfully visualized and evaluated with a thin bronchoscope. No significant complications were associated with the procedures. Conclusion: The thin bronchoscope can be a useful tool for evaluating a severely stenosed airway during the stenting procedure.

Randomized Study of Endobronchial Ultrasound-Guided Transbronchial Biopsy: Thin Bronchoscopic Method versus Guide Sheath Method

“…Conventional thin bronchoscopes less than 3.9 mm in external diameter equipped with a 1.2-mm working channel, 18,19 and eventually thin bronchoscopes with a 1.7-mm working channel which allow the use of a thin radial ultrasonic probe have recently been developed. 9,10,20 In a former preliminary study, 9 we demonstrated that the diagnostic yield of EBUS-TBB with the thin bronchoscope for peripheral pulmonary lesions with a mean size of 31 mm was 69%. The results of this study are consistent with those of the former preliminary study.…”

Double Y-stenting for tracheobronchial stenosis

“…Cases where the bronchus beyond the segmental bronchus was invaded and obstructed (e.g. cases with the tumour extending from the peripheral bronchus) were revealed by flexible bronchoscopes [11], and we did not consider as having indications for stenting. The size and length of the stent are decided using a flexible bronchoscope, endobronchial ultrasound with a balloon and pre-procedural computed tomography as previously described [12].…”

Techniques of endoscopic airway tumor treatment

“…Silicone stents can be straight or bifurcated for stenoses that involve the carina or primary right carina (Oki stent) (106,114). The diameter and size are chosen based on scanographic and per-operative bronchoscopic data, which are then adjusted by cutting (37,75,108,(115)(116)(117).…”