Bronchoscopy is an endoscopic technique that uses a flexible optical instrument (bronchoscope) to enter the respiratory tract, allowing direct visualization of the trachea, bronchi, and lung structures. Its primary uses include diagnosing abnormal lesions, collecting tissue samples for pathological analysis, and performing therapeutic procedures such as foreign body removal or airway dilation. This procedure provides real-time imaging and tissue specimens, making it an essential tool for diagnosing and intervening in respiratory system diseases.
Bronchoscopies are categorized into "diagnostic bronchoscopy" and "therapeutic bronchoscopy." Diagnostic procedures utilize high-resolution cameras combined with tissue biopsies or brushings to determine infections, tumors, or inflammation levels. Therapeutic bronchoscopy incorporates specialized instruments, such as laser ablation to destroy obstructive tissue, stent placement to expand narrowed airways, or suction techniques to clear mucus plugs.
Common indications include unexplained chronic cough, lung shadows or nodules, recurrent pneumonia, suspected lung cancer diagnosis and staging, and airway obstruction causing breathing difficulties. Additionally, when sputum analysis cannot clarify the cause, bronchoscopy allows direct sampling of deep tissue, suitable for difficult cases such as tuberculosis and pulmonary fungal infections.
Patients need to undergo local anesthesia spray or general anesthesia beforehand. The physician inserts a bronchoscope approximately 5-10 mm in diameter through the nose or mouth, gradually advancing along the trachea. The entire procedure is monitored with tracking devices, and alveolar lavage or tissue sampling may be performed as needed. The duration varies based on complexity, with basic diagnostics taking about 15-30 minutes, and complex treatments lasting 1-2 hours.
Its minimally invasive nature significantly reduces complication risks, causes less postoperative pain, and provides critical diagnostic information for early lung cancer, enhancing treatment timeliness.
Common short-term reactions include sore throat, cough, or minor bleeding, usually resolving within 24-48 hours. Serious complications include pneumothorax (occurring in about 0.5-2%), severe bleeding, or anesthesia allergic reactions. A very small number of patients may experience bronchospasm leading to breathing difficulties, requiring immediate intubation.
Contraindications include severe coagulation disorders, uncontrolled pneumothorax or aortic aneurysm, and severe heart-lung failure. Fasting for 4-6 hours before the procedure is necessary. Patients with poor cardiopulmonary function should first evaluate anesthesia risks. After the procedure, avoid eating hot foods immediately, and do not operate heavy machinery within 24 hours to prevent anesthesia-related sequelae.
When combined with general anesthetics, caution is needed regarding increased bleeding risk with anticoagulants (such as warfarin). Patients on immunosuppressants should have medication adjustments to prevent infectious complications. Compared to CT or PET-CT imaging, bronchoscopy allows direct tissue sampling, providing more definitive diagnostic evidence.
According to international respiratory medicine research, bronchoscopy has a diagnostic accuracy of over 90% for lung cancer. Bronchoalveolar lavage improves pathogen detection rates in lung infections by 30-50% compared to traditional sputum cultures. Therapeutic bronchoscopy for removing obstructions can immediately improve ventilation, with lung function tests showing an average increase of 15-20% in FEV1 (forced expiratory volume in 1 second).
If patients cannot tolerate anesthesia, non-invasive assessments such as high-resolution chest CT scans or PET-CT scans can be considered. However, these methods cannot obtain tissue samples. For therapeutic interventions, thoracotomy or bronchial dilation may be alternatives, but they involve longer recovery and more trauma.
Transient sore throat or mild cough after the procedure is common, usually caused by irritation from the scope passing through the vocal cords or local anesthetics. It is recommended to avoid solid foods within 2 hours post-procedure, and lozenges or warm water can help soothe symptoms. If symptoms persist beyond 48 hours, contact healthcare providers immediately.
Should I adjust my anticoagulant medication before bronchoscopy?Yes, if you are taking anticoagulants (such as aspirin or warfarin), inform your doctor at least 48 hours prior to the procedure to consider stopping or adjusting the dose to reduce bleeding risk. The specific plan should be based on your coagulation status and disease severity as assessed by your physician.
Is hospitalization necessary after bronchoscopy?Most patients can go home the same day, but should be accompanied by family and refrain from eating or drinking for 2 hours to prevent choking. If biopsies or hemostasis were performed or if the patient has severe cardiopulmonary disease, observation for 4-6 hours may be required, with discharge based on clinical assessment.
When can I resume normal activities or flying after the procedure?It is generally recommended to avoid strenuous exercise and flying within 24 hours post-procedure, as pressure changes may affect the respiratory tract. If the procedure was smooth and without complications, most patients can gradually resume daily activities after 48 hours, but should avoid vigorous coughing.
How accurate is bronchoscopy biopsy? Is there a risk of missing the lesion?Biopsy accuracy ranges from 80-90%, with sampling sites and numbers adjusted based on lesion characteristics. If the lesion is located deep within a narrow bronchus or is small, multiple samples may be needed. Physicians will cross-verify with imaging and pathology results, and follow-up examinations may be recommended to improve diagnostic accuracy.
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