What Is Bronchoscopy?
Bronchoscopy is a procedure that allows physicians to examine the lungs and airways. It is often conducted by a pulmonologist (specialist in lung problems). During bronchoscopy, a narrow tube (bronchoscope) is inserted via the nose or mouth, down the throat, and into the lungs.
Most bronchoscopies are conducted with a flexible bronchoscope. However, a rigid bronchoscope may be required if there is significant bleeding in the lungs or if a large object is lodged in the airway.
Frequent indications of the need for bronchoscopy include a chronic cough, an infection, or an abnormal finding on a chest X-ray or other test.
Bronchoscopy may also be used to gather mucus or tissue samples, remove foreign bodies or other obstructions from the airways or lungs, or treat lung disorders.
Why Is It Done?
Typically, a bronchoscopy is performed to determine the source of a lung disorder. For instance, your physician may recommend a bronchoscopy if you have a chronic cough or an abnormal chest X-ray.
Among the reasons for performing a bronchoscopy are:
- Diagnosis of a lung condition
- Identification of a respiratory illness
- Tissue biopsies from the lungs
- Mucus, foreign bodies, or other obstructions in the airways or lungs, such as a tumour.
- The placement of a tiny tube to maintain an open airway (stent)
- Treatment of a lung condition (interventional bronchoscopy), such as bleeding, an abnormally narrowed airway (stricture), or a collapsed lung (pneumothorax)
During certain procedures, special equipment, such as a tool to take a biopsy, an electrocautery probe to stop bleeding, or a laser to diminish the size of an airway tumour, may be introduced through the bronchoscope. Special procedures guide the collection of biopsies to guarantee that the desired lung region is collected.
A bronchoscope with an integrated ultrasound probe may be used to examine the lymph nodes in the chest of lung cancer patients. This is known as endobronchial ultrasonography (EBUS), and it assists physicians in determining the most effective treatment. EBUS may be utilized to determine the spread of various types of cancer.
Complications associated with bronchoscopy are uncommon and often modest, although they can occasionally be severe. Inflamed or disease-damaged airways may increase the likelihood of complications. Complications may be caused by the surgery, the sedative, or the topical anaesthetic.
Bleeding: Bleeding is more common if a biopsy was taken. Typically, minor bleeding ceases without treatment.
Collapsed lung: In rare instances, bronchoscopy may cause injury to the airway. If the lung is pierced, air might gather in the space surrounding the lung, resulting in the collapse of the lung. Typically, this issue is easily treatable, but hospitalization may be necessary.
Fever: Fever is common following bronchoscopy but is not usually indicative of an infection. Treatment is typically unnecessary.
What Is Pleuroscopy?
Pleuroscopy is a medical technique involving the insertion of a scope (called a pleuroscope) into the pleural cavity through an incision created between the ribs. This is the fluid-filled area between the lungs’ two membranes (pleura). Pleuroscopy is a minimally invasive treatment performed under anaesthesia to diagnose lung diseases such as lung cancer or tuberculosis or to treat the abnormal accumulation of fluid in the pleural space (pleural effusion).
Pleuroscopy is typically well tolerated. However, it might induce infection, haemorrhage, and other adverse surgical effects.
Why Is It Done?
Pleuroscopy is typically a secondary diagnostic or therapeutic method for disorders affecting the pleural cavity. It is often performed following less invasive treatments such as ultrasound, computed tomography (CT) scans, and thoracentesis (the evacuation of pleural fluid with a needle).
Pleuroscopy has four indications in general:
Diagnosis: Commonly, pleuroscopy is used to examine the pleural cavity for abnormalities, such as infections, lung cancer, mesothelioma (cancer of the pleura), and lung cancer metastases. Bronchoscopy cannot provide views of the lung’s outer margins, although pleuroscopy can.
Biopsy: Pleuroscopy can give video-assistance guidance of a biopsy. The tissue sample can then be sent to the laboratory to determine whether cancer or infection is present. The biopsy can be conducted using fine-needle aspiration, core needle biopsy, or a newer technique known as cryobiopsy, in which frozen tissue is retrieved using forceps.
Fluid drainage: Pleuroscopy enables medical professionals to quickly drain fluid from patients with pleural effusion while visually examining the pleural cavity. The pleural fluid might also be sent to a laboratory to determine whether it contains cancer cells (called malignant pleural effusion).
Pleurodesis: During pleuroscopy, chemicals can be administered in patients with severe or recurring pleural effusion to bind the membranes and prevent fluid from reaccumulating. Pleurodesis is commonly performed on individuals with malignant pleural effusion, recurrent pleural effusion, or chronic or recurrent pneumothorax (collapsed lung)
There are only a few absolute and relative contraindications to pleuroscopy, making it a generally safe treatment.
Anyone with severe adhesions (i.e. sticking together) of the pleural membranes should never undergo pleuroscopy. Past respiratory infections, chest radiation, asbestosis, and difficulties from heart bypass surgery can cause pleural adhesions.
Less frequently, pleuroscopy may be contraindicated in patients with severe bleeding diseases, such as haemophilia, or significant respiratory insufficiencies, such as those seen in cystic fibrosis, stroke, and advanced chronic obstructive pulmonary disease (COPD).
Patients with an active respiratory illness, such as pneumonia, or those suffering from a recent heart attack should not undergo pleuroscopy until their condition has stabilized.
Even though pleuroscopy is considered less invasive, it bears the same risks as any surgical treatment, such as anaesthesia-related complications.
EBUS (Endobronchial Ultrasound) Bronchoscopy)
What Is EBUS?
An EBUS (endobronchial ultrasound) bronchoscopy is used to identify various lung conditions, such as inflammation, infections, or malignancy. EBUS bronchoscopy is carried out by a pulmonologist and involves inserting a flexible tube through your mouth into your windpipe and lungs. The EBUS scope contains a video camera and an ultrasound probe connected to provide a local image of your lungs and associated lymph nodes in order to precisely find and assess spots visible on x-rays or scans that need a closer look. It is similar to but smaller than the instrument used during a colonoscopy.
What To Expect From The Procedure?
Depending on when the treatment is scheduled, your doctor may order bloodwork before your procedure, and the evening before, you will be urged to refrain from eating or drinking after midnight. You will be given an IV on the day of your procedure to receive drugs that will keep you at ease while it is being done. You may occasionally be put to sleep using an anaesthetic. Your doctor will start the EBUS bronchoscopy once you are at ease or asleep and insert the camera into your mouth.
Your doctor will inspect and obtain lung samples, typically with a small needle, using the camera and the ultrasound. A slight cough and sore throat are possible, but they should go away a day later.
The EBUS bronchoscopy is an outpatient procedure, and after a brief observation period, you will often be allowed to return home. After the treatment, you will need to arrange for someone to drive you home.
Although EBUS bronchoscopy is very safe, there is a minimal chance of complications, including bleeding from the biopsy, infection after the surgery, low oxygen levels during or after the procedure, and a slight possibility of lung collapse. Although all these side effects are curable, you might need to spend a short time in the hospital rather than leave after your treatment. Remember to let your doctor know if you’ve ever experienced complications from sedatives or anaesthesia.
Department of Pulmonary Medicine & Critical Care
Department of Pulmonary Medicine is lead by:
Dr. Diksha Tyagi
Senior Consultant, Pulmonary & Critical care Medicine
MBBS, MD, DM (Pulmonary & Critical Care Medicine)
EDRM (European Diploma of Adult Respiratory Medicine)
Dr Diksha Tyagi is the first DM in Pulmonary & Critical Care Medicine in Meerut. She is heading an exclusively dedicated interventional pulmonology unit in Meerut. She is doing all the basic and advanced bronchoscopic procedures like fibreoptic bronchoscopy, EBUS guided FNAC and biopsy, Pleuroscopy and Rigid Bronchoscopy.
She has clinical experience of more than 12 years in diagnosis and management of various respiratory diseases. She is extensively trained in critical care unit in managing patient on invasive and non- invasive mechanical ventilation. She is known for her passionate and humble nature with excellent communication skills.
Expert Management in:
- Asthma & Allergy
- Chronic Obstructive Pulmonary Diseases
- Interstitial Lung Diseases
- Lung Cancer
- Occupational Lung disease
- Pleural Diseases
- Pulmonary thromboembolism
- Pulmonary Hypertension
- Sleep disorders
Interventional Pulmonary services:
- Flexible bronchoscopy
- Rigid bronchoscopy
- Medical Thoracoscopy/ Pleuroscopy
- Endobronchial ultrasound (EBUS) guided FNA/ biopsy
- Paediatric bronchoscopy and foreign body removal
- Tracheal stenting
- Endobronchial tumor debulking
Complete Pulmonary Function Testing:
- Diffusion Lung Capacity (DLCO)
- Lung Volumes