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Flexible Bronchoscopy

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Interventions in Pulmonary Medicine

Abstract

Flexible bronchoscopy (FB) is the most common procedure used to evaluate the airway. It is minimally invasive and it can be performed under local anesthesia and conscious sedation. FB can have Diagnostic and Therapeutic indications.

FB has been applied for more than 45 years to diagnose many airway conditions, being the most common ones lung cancer, lung infections, hemoptysis and interstitial lung disease. In lung cancer diagnosis, many techniques have been developed such as autofluorescence bronchoscopy, endobronchial ultrasound, electromagnetic navigation, high magnification bronchoscopy, narrow band imaging, confocal fluorescence microendoscopy, multimodality fluorescein imaging and optical coherence tomography, oriented to an early detection.

Therapeutic FB has gained popularity and has rapidly evolved during the last years. Many therapeutic interventions have developed, mainly oriented to treat lung cancer complications. The most important indication for therapeutic bronchoscopy is central airway obstruction for malignant or non malignant conditions. Modalities available include the so called fast methods to re open the airway (laser, electrocautery, argon plasma coagulation, cryoextraction) and the slow methods (conventional cryotherapy, photodynamic therapy, brachytherapy). Regarding stent placement (often required to support the airway wall), metallic self expandable prosthesis are the only ones designed to be placed under FB, and their application is limited to malignant conditions.

New therapeutic interventions are represented by the application of thermoplasty for severe bronchial asthma, and endoscopic lung volume reduction for selected patients with severe emphysema.

Most of the therapeutic interventions can be applied with the FB.

FB has many advantages: is broadly available and versatile, most of the pulmonary physicians are trained in the FB technique, particularly in its diagnostic modality. It allows a complete inspection of the airway and it is minimally invasive. Disadvantages include the inability to control the airway to confront some situations (such as critical acute airway obstruction and severe hemoptysis).

In well trained hands, it is an irreplaceable diagnostic and therapeutic tool. As new techniques develop, it is expected that the FB indications will further expand in the future.

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Authors and Affiliations

  1. Pulmonary Department, Clinica Y Maternidad Colon, Avenida Colon 3629 Consultorio 1, Mar Del Plata, Buenos Aires, 7600, Argentina

    Alicia N. Rodriguez M.D.

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  1. Alicia N. Rodriguez M.D.
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Correspondence to Alicia N. Rodriguez M.D. .

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Editors and Affiliations

  1. MD Anderson Cancer Center, Houston, TX, Department of Pulmonary Medicine, Bellvitge University Hospital, Barcelona, 08907, Spain

    Jose Pablo Díaz-Jimenez

  2. Clinica Y Maternidad Colon, Pulmonary Department, Mar Del Plata, Buenos Aires, 7600, Argentina

    Alicia N. Rodriguez

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Rodriguez, A.N. (2013). Flexible Bronchoscopy. In: Díaz-Jimenez, J., Rodriguez, A. (eds) Interventions in Pulmonary Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6009-1_2

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  • DOI: https://doi.org/10.1007/978-1-4614-6009-1_2

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