Who should and should not perform flexible bronchoscopy?

The article was professionally consulted by Specialist Doctor I Nguyen Tuan Lam - Ear, Nose Throat Doctor - Department of Medical Examination and Internal Medicine - Vinmec Ha Long International Hospital

Bronchoscopy is a procedure that allows the doctor to examine the inside of the bronchial tree system as far as the lung parenchyma. With a flexible tube, this means will help the doctor to reach deep into the small airways. The endoscopic process is quick and painless, and the patient recovers quickly.

Bronchoscopy or bronchoscopy is a procedure to look directly into the airways in the lungs using a thin tube, with a light source and a camera attached during the procedure.
The inlet of the bronchoscope is placed in the nose or mouth. The endoscope will be moved down the throat, through the trachea, into the bronchi and into the divisions. Thanks to that, the doctor can see the entire airway such as: larynx, trachea, bronchi and small branches of bronchi, bronchioles.
There are two types of bronchoscopes: rigid bronchoscope and flexible bronchoscope. Each type has its own advantages and is used in different situations. However, in practice, flexible bronchoscopy is used more often. Compared to rigid bronchoscopes, flexible bronchoscopes are more flexible and can travel down smaller airways such as bronchioles. As a result, a flexible bronchoscope can be used to place a breathing tube in the airway to help deliver oxygen, aspirate secretions, take tissue samples for biopsies, or inject therapeutic drugs into the lungs.

Indications for flexible bronchoscopy in the group of respiratory pathologies are numerous. Depending on the situation and the goal to be achieved, the implementation process will take place in different ways.

Acute and chronic respiratory signs and symptoms are the most common indications for diagnostic bronchoscopy:
Chronic cough Hemoptysis Lung collapse Obstructive pneumonia Wheezing Lung cancer is a of the most common conditions requiring bronchoscopy. The goal of the procedure is to:
Early diagnosis Diagnose at the histological level Staging Patients with burns and suspected respiratory tract injuries need bronchoscopy to confirm.

Foreign body removal: In general, foreign body removal is best done with rigid bronchoscopy under general anesthesia. However, flexible bronchoscopy will have the advantage of more flexibility and the ability to access the bronchi at a deeper location, with a smaller size. Lung abscess: Endoscopy to remove damaged tissue and drain pus. Tracheal stenosis: Insert a catheter to dilate the airways through the endoscope. Atelectasis: Inflating the balloon inflates the alveolar sacs. Pulmonary irrigation: Endoscopy to pump physiological saline to wash the lungs in occupational pneumonitis, primary alveolar proteinosis Pneumonia, diffuse lung disease: Bronchoscopy is performed to collect secretions from the airways Aspiration, culture of bacteria to diagnose infection. Difficult intubation: Before patients with difficult intubation, a bronchoscope can be used to make manipulation easier.

There are no absolute contraindications for flexible bronchoscopy.
However, there are many of the following situations that can be considered as relative contraindications to endoscopy. Accordingly, if the indication for endoscopy is really necessary, special precautions should be taken for these patients.
Uncooperative patient: Uncooperative or psychotic patients are not suitable candidates for bronchoscopy under local anesthesia. At this point, bronchoscopy must be performed under general anesthesia. Acute Myocardial Infarction: Recent-onset myocardial infarction, unstable angina, and severe arrhythmia are relative contraindications to a bronchoscopy. CO2 Congestion: CO2 retention is a consideration for the indications for bronchoscopy. However, the patient should be closely monitored and intubated if endoscopy is necessary. An alternative is to intubate the patient and perform bronchoscopy in a controlled situation on a ventilator. Low O2: Need to supplement oxygen to reach oxygen concentration above 65mmHg before need to perform endoscopy. Coagulation dysfunction: There are no complete contraindications for bronchoscopy in patients with coagulopathy. However, because the procedure can cause bleeding that is difficult to stop, caution is needed in the endoscopic manipulation of these subjects. Even so, endoscopic biopsy is completely contraindicated. Tracheal stenosis: If the narrowing is too tight, the endoscope can completely block the airway.

Asthma: Bronchial asthma can cause severe laryngospasm and bronchospasm during bronchoscopy. For these patients, steroids and bronchodilators should be ready before the procedure so that the procedure can be carried out safely. Superior vena cava syndrome: This was once considered a contraindication for bronchoscopy due to the increased risk of bleeding, especially with bronchoscopy with biopsy. In summary, bronchoscopy is generally a relatively safe diagnostic and interventional procedure with little risk of complications. However, before performing it, it is necessary to properly consider the indications as well as who should and should not perform flexible bronchoscopy to achieve the best results.
At Vinmec International General Hospital, bronchoscopy technique under anesthesia is performed by a team of well-trained, experienced doctors in modern and advanced medical equipment, ensure strict technical standards, thus giving high accuracy diagnostic results.