Techniques in Bronchoscopy

Overview

Bronchoscopy is the most important tool in diagnosing respiratory disorders. Diagnostic indications are numerous and range from bronchial wash or bronchoalveolar lavage, in case of pulmonary infiltrations, to transbronchial lung biopsies in peripheral solitary pulmonary nodules. Different techniques, such as peripheral endobronchial ultrasound probes, or different navigation systems facilitate diagnosis of peripheral pulmonary lesions. Furthermore, endobronchial-guided transbronchial needle aspiration gained increased significance for mediastinal staging in lung cancer patients. Bronchoscopy also offers many therapeutic modalities. In case of haemoptysis, cold saline lavage, instillation of topical vasoconstrictive agents, endobronchial airway blockade, laser therapy, argon plasma coagulation and electrocautery present useful tools. Another indication for therapeutic bronchoscopy is a central airway obstruction resulting from benign or malignant processes. Rapid symptom control can be achieved by laser-assisted resection, electrocautery and cryodebridement. Furthermore, the insertion of an airway stent re-establishes the patency of obstructed airways. Brachytherapy is another treatment option for malignant airway stenoses. Due to its delayed effects, brachytherapy should only be considered in respiratorily stable patients. Recently developed therapeutic modalities are endoscopic lung volume reduction in patients with chronic obstructive pulmonary disease and bronchial thermoplasty in patients with asthma.