Bronchoscopy

Bronchoscopy is a procedure done to look inside the air passages of your lungs. In the most common type, flexible bronchoscopy, a thin and flexible scope is inserted through your nose or mouth. The scope, called a bronchoscope, is passed down the back of your throat and between your vocal cords to enter the air passages. A camera in the scope sends pictures to a video screen during the procedure. 

Another type of bronchoscopy is called rigid bronchoscopy. This procedure also looks inside the air passages of your lungs, but the tube is larger and not flexible. A rigid scope can only be placed through your mouth. It’s less common than flexible bronchoscopy. 

How do you prepare for bronchoscopy?

There are several guidelines in preparation of bronchoscopy, which is usually an outpatient procedure:

• You may need a chest X-ray or chest CT scan before the procedure.
• Don’t eat or drink anything after midnight.
• Ask your care team if it’s safe to take your usual medications on the day of surgery.
• If you take a blood thinner or a non-steroidal anti-inflammatory drug (NSAID), like aspirin or ibuprofen, ask your doctor when you should stop these drugs before the procedure to reduce your risk of bleeding.
• Stop smoking for as long as possible before the procedure if you are a smoker.

What are the risks and complications of bronchoscopy?

• Bleeding
• Pneumonia
• Pneumothorax, the collapse of part of the lung

Pneumothorax is a rare complication that may occur when a biopsy is taken. A leak of air from the lung can escape into surrounding tissue and cause part of the lung to collapse. A small leak may close without treatment, but a collapsed lung must be treated with a chest tube to re-expand the lung, according to the Chest Foundation.

What happens after the procedure?

After the procedure, you’ll be brought to an area to recover from your sedation or general anesthesia. Until you’re awake and any numbness in your throat has worn off, you will not be allowed to eat or drink. Recovery may take anywhere from one to three hours.

You may also be given a chest X-ray to make sure there is no evidence of pneumothorax before you go home. It may take a few days to get results of tests or biopsies done during the procedure. However, your doctor may describe what was found during the procedure before you go home.

Once home, it’s normal to have some soreness in your throat. It’s not uncommon to have a low-grade fever for a day or two, but let your doctor know if you have any of these symptoms:

• Persistent chills or fever
• Persistent cough or throat pain
• Coughing up blood
• Shortness of breath

What happens during the procedure?

If you’re having flexible bronchoscopy, the procedure is usually performed with intravenous (IV) sedation. Rigid bronchoscopy is performed under general anesthesia, which means you’ll be asleep.

You will receive oxygen throughout the procedure whether you’re awake or asleep. The procedure usually takes about 30 to 60 minutes. It may take longer if you have an imaging study during the procedure, such as an endobronchial ultrasound, which creates images with sound waves from inside your lung.

Steps routinely used for flexible bronchoscopy include:

• An IV will be started in your arm. If you receive sedation, you’ll get a medicine through the IV to make you feel relaxed and sleepy.
• You will be placed on a bed or table with your head tilted upwards.
• If you’re having sedation only, a numbing spray may be placed into your nose or mouth.
• The bronchoscope will be passed down your throat and through your vocal cords.
• Your oxygen level, blood pressure and heart rate will be monitored.

During the procedure, your doctor will examine your airways and perform tests or procedures as needed.

Why is bronchoscopy done?

There are many reasons for flexible bronchoscopy. The most common ones include:

• If you have frequent lung infections, samples of lung tissue or secretions can be removed through the scope and studied in the lab.
• If an imaging study shows a spot on your lung, a piece of lung growth may be taken to diagnose a cancerous tumor or another condition. Taking a piece of tumor to study under a microscope is called a biopsy.
• If an area of your lung has become blocked and has collapsed, called atelectasis. Thick mucus, or a foreign body (like a piece of peanut), may be removed. If it’s a tumor, it may be biopsied.
• If you’re coughing up blood, bronchoscopy may determine the cause. It can be an abnormal blood vessel or a tumor. In some cases, bleeding can be treated through the scope.
• Bronchoscopy may be done to find out why you have trouble breathing or noisy breathing. There are many causes of obstructed breathing that can be found during bronchoscopy.

Bronchoscopy may also be done if you’ve been diagnosed with lung cancer to find the stage of your cancer—how far cancer has grown—and to decide if the cancer can be removed by surgery or needs a different type of treatment.

Although rigid bronchoscopy is an older procedure that has mainly been replaced by flexible bronchoscopy, rigid bronchoscopy is still important for certain conditions. These include removing a central airway obstruction that is too large for the flexible scope, removing a large foreign body and treating severe bleeding.