Diagnostic and therapeutic bronchoscopy techniques

Today, thanks to the development of science and technology, there are many new techniques applied in medicine that contribute to better diagnosis and treatment of respiratory diseases for patients. By using a video camera inserted into the bronchus for injury survey as well as for procedural intervention, bronchoscopy is an effective means of diagnosis and treatment of suspected lung lesions.

Bronchoscopy (with a flexible tube) is a minimally invasive or minimally invasive procedure. By inserting a flexible tube with a camera attached to the end of the tube, the doctor can help the doctor see the inside of the airways, detecting the damage more clearly.
In addition, bronchoscopy also allows the doctor to biopsy tissue samples from suspected lesions, take cells and lung fluid for diagnostic pathology tests. In addition, newly developed diagnostic and therapeutic bronchoscopy techniques are now capable of combining with other means such as imaging, nuclear medicine, laser or ultrasound to increase efficiency. diagnostic results.

Bronchoscopy is divided into two main groups with the intended use including diagnostic endoscopy and therapeutic endoscopy. Diagnostic endoscopy helps to increase the ability to detect lesions early and accurately locate lesions for effective biopsies. Endoscopic treatment techniques have many advantages because of their low invasiveness, high efficiency and safety.

Includes techniques:
- Narrow Band Imaging
- Autofluorescence Bronchoscopy
- Endobronchial Ultrasound
- Technique Electromagnetic Navigation
- Optical coherence tomography
- Confocal Fluorescence/Laser Endomicroscopy

It is divided into the following main groups:
- Methods of treating central airway obstruction:
+ Endoscopic techniques combined with mechanical cutting
+ Endoscopic techniques combined with thermocoagulation (Thermocoagulation), electrocoagulation ( Electrocoagulation)
+ Endoscopic technique combined with laser treatment (Laser therapy)
+ Endoscopic technique combined with photochemotherapy
+ Endoscopic technique combined with cryotherapy (Cryotherapy)
+ Technique Endobronchoscopy combined with bronchial radiation therapy (Brachytherapy)
+ Endoscopic technique combined with stenting
- Bronchoscopy to remove bronchial foreign bodies
- Endoscopic technique combined with hemostasis treatment in cough blood
- Endoscopic technique combined with bronchoalveolar lavage (Bronchoalveolar lavage) treatment

- Some new treatment methods are currently available:
+ Endoscopically reducing bronchial smooth muscle (Bronchial thermoplasty)
+ Endoscopic lung volume reduction (Bronchoscopic lung volume reduction)

- Based on the principle of using light sources emitted from three frequency bands respectively from B1 (400 - 430 nm), B2 (430 - 470 nm), B3 (560 - 590 nm). At that time, the intravascular hemoglobin strongly absorbs narrowband wavelengths, especially the B1 waveband. Therefore, this technique helps to detect early lesions with angiogenesis, invasion of the airways, helps to orient the location of proliferative lesions in the bronchial mucosa and increases the efficiency of lesion biopsy.
- The images detected on narrow light endoscopy such as vascular proliferation, vascular spot, dilated vessels, zigzag, spiral or amputated blood vessels.

- The affected bronchial area is usually sensitive to fluorescent light and will become reddish brown. Therefore, when applying this technique, it will help to easily detect lesions from 1.5 to 2.5 times. Fluorescent bronchoscopy also helps detect lung cancer early, evaluates changes in bronchial areas that are not visible to the naked eye. (See also: 5 early signs of lung cancer you need to know)

- The technique of combining ultrasound waves attached to the end of the endoscope helps to survey the tissues below the mucosa. Endoscopic ultrasound technique helps to evaluate the lymph node system around the trachea and the lesions in the mediastinum, to locate other tumors that invade deep in the bronchial lumen, to drain air cysts or mediastinal cysts.

- By using the electromagnetic probe at the end of the endoscope, it is possible to recreate the CT images to help identify the lesion. This technique helps to assess well the lesions of the lung periphery, hilar nodes and mediastinum.

- Similar to computed tomography technique, but endoscopic tomography has a signal generator at the endoscope. Endoscopic computed tomography helps in detailed assessment of airway structures (tracheobronchial), biopsy of peripheral and transbronchial tumors.

- When directing narrow wavelength light to the lesion site and then capturing the light reflection through the signal receivers, confocal laser/fluorescence microscopy can evaluate the Microstructure of central and peripheral airway lesions at the cellular and histological levels.

- Photochemical treatment techniques: When researchers discovered the susceptibility of tumors to hematoporphyrin, photochemotherapy techniques began to be applied. Malignant proliferative cells often accumulate photosensitive substances, so when irradiated with monochromatic light currents, these malignant cells will die due to the generation of free radicals and damage to the tissues. endothelial cells cause secondary embolism.
- Mechanical treatment techniques; Using biopsy pliers to destroy the tumor
- Laser treatment technique: shining a laser on the damaged tissue, the malignant cells will absorb the energy and be destroyed by the laser.
- Technique of treatment by thermocoagulation: Using burning electrodes inserted through the endoscope, heat or electricity will dehydrate cells and cause cell necrosis.
- Cryotherapy technique: using cold heat to dehydrate cells, causing intracellular hypertonicity, creating ice crystals inside and outside the cells. From there, the cells ruptured the cytoplasmic membrane and ruptured the nucleus, causing secondary vasoconstriction, creating micro-obstruction lumps causing necrosis of tumor cells.
- Technique of tracheobronchial stenting: in cases where the tumor has invaded to late stages, obstructing the airways, stents (stent, prothese) can be indicated to help recanalize. respiratory tract for the patient.
- Techniques for endobronchial radiation therapy: indicated in central malignant tumors, granulomatous tumors after lung transplantation.

- Bronchoscopy is also used in cases where the patient has a foreign body in the bronchi that is taken through the flexible endoscope.
- Besides, based on techniques such as ablation, vasopressor injection, compression, bronchoscopy is also used to treat hemostasis in patients with hemoptysis.
- Some other techniques have a lot of potential for future development such as therapeutic bronchoalveolar lavage, reducing bronchial smooth muscle mass by radio waves or reducing lung volume by causing atelectasis. puncture or bridge blocked airways.
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See more:
Role of bronchoscopy in diagnosing respiratory diseases Bronchoscopy to diagnose and treat respiratory diseases Flexible bronchoscopy : What you need to know