Bronchoscopy

The airways branch from the windpipe, or trachea, into the two main bronchi and then into smaller and smaller tubes that carry air deep into the lungs. A bronchoscope is a thin tube with a light and a camera at its tip that is passed through the nose or mouth, past the voice box and into these airways, showing their lining on a screen. The flexible bronchoscope, only a few millimetres wide, bends to reach the smaller branches and has a working channel through which fine instruments can take samples. Endobronchial ultrasound, called EBUS, adds a small ultrasound probe that shows lymph nodes and masses lying just outside the airway wall, so that they can be sampled with a needle. The rigid bronchoscope is a straight, wider metal tube that gives a large channel for treatment in the windpipe and main airways. Navigation systems can guide a thin scope towards small nodules further out in the lung.

Diagnostic bronchoscopy is recommended when a chest X-ray or CT scan shows a shadow, nodule or mass that needs a tissue diagnosis, or when lymph nodes in the centre of the chest are enlarged. EBUS sampling is a standard way to find out whether lung cancer has spread to these nodes, which shapes whether surgery, radiotherapy or another treatment is chosen, and it also helps diagnose conditions such as sarcoidosis and tuberculosis. Other reasons include coughing up blood, a cough that persists without explanation, pneumonia that keeps returning in the same area or does not clear, and lung infection in people with weak immunity, where fluid washed from the lungs can identify the organism. Interventional bronchoscopy is used to remove an inhaled object, open an airway narrowed by a tumour or scar tissue, stop bleeding or place a stent. Your specialist weighs the scans, symptoms and general health before advising it.

You fast for about six hours beforehand. For a flexible bronchoscopy, a local anaesthetic spray numbs the nose and throat, a sedative given through a vein makes you drowsy and relaxed, and oxygen and monitoring are used throughout. The scope is passed through the nose or mouth, and more local anaesthetic is dripped onto the vocal cords and airways to settle the urge to cough. The specialist inspects each airway and may wash a small area with saline and collect the fluid, a step called bronchoalveolar lavage, brush the lining or take small biopsies. With EBUS, a needle is passed through the airway wall into lymph nodes under ultrasound view. Biopsies of the lung tissue itself may be guided by live X-ray. A flexible procedure usually takes about 20 to 60 minutes. Rigid bronchoscopy is done under general anaesthesia, and its wide tube allows instruments, lasers, freezing probes or balloons to remove obstructions and place stents.

Most adults and children can have a bronchoscopy, although the team takes extra care in people with severe breathlessness, low oxygen levels, a recent heart attack or a bleeding tendency. Before the procedure you will usually need a recent CT scan of the chest, which guides where samples are taken, along with blood tests including clotting, and sometimes breathing tests and a heart check. Blood thinners and some diabetes medicines are paused or adjusted on medical advice, and you should tell the team about allergies and about loose teeth or crowns. Because sedation affects judgement for the rest of the day, an adult companion should take you back to your accommodation, and you should not drive or sign important documents until the next day. International patients can usually send recent scans and reports in advance, so the team can decide whether a flexible, EBUS or rigid procedure fits the question before you travel.

After the scope is removed you rest for one to two hours while the sedation wears off. You do not eat or drink until the numbness in your throat has gone, usually after an hour or two, so that you do not choke. A sore throat, a hoarse voice, a cough with a little blood-stained sputum and a mild fever on the evening of the test are common and settle within a day or two. Most people return to normal activity the next day. If lung tissue was sampled, a chest X-ray may be taken to check for a collapsed lung, and your team will advise when it is safe to fly. Plan your stay around the results: samples are examined by a pathologist and usually take a few days to about a week, longer for cultures or molecular tests, so many people either stay for the results visit or arrange a remote follow-up consultation.

Bronchoscopy is a commonly performed and generally safe procedure, and serious complications are uncommon. Expected minor effects are a sore throat, coughing, a hoarse voice and a brief fever. Bleeding after a biopsy is usually small and stops by itself or with simple measures through the scope. A pneumothorax, where air leaks into the space between the lung and the chest wall, can occur after lung tissue biopsies; small ones settle on their own, while larger ones need a chest drain and a hospital stay. Sedation can lower breathing or blood pressure, which is why oxygen and monitoring are used, and a few people react to the local anaesthetic or have a spasm of the airways. Rigid and interventional procedures carry more risk. A bronchoscopy does not always give a final answer: if samples are inconclusive, a repeat procedure, a needle biopsy through the chest wall or surgery may be suggested.