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Bronchial endoscopy

Principle

A bronchial endoscopy involves introducing an endoscope (less than 1 cm in diameter) through the mouth. The endoscope is flexible and allows visual examination of the trachea and bronchi. The examination allows samples (including biopsies) to be taken and treatment to be given, for example, identifying a source of bleeding and a procedure designed to stop the bleeding.

 

Technical details of the examination:

 

Preparation

- As an outpatient or in-patient
- Injection of a substance to dry out the airways (to reduce the discomfort caused by the examination)
- Injection of a sedative
- Local anaesthetic (mouth, throat, vocal cords and airways) by using an anaesthetic spray and injecting a liquid containing an anaesthetic into the airways
- Nil by mouth for at least 4 hours

Oxygen may be administered through the nose throughout the examination, in order to prevent complications as far as possible. The amount of oxygen in the blood is also monitored continually during the examination.

Contraindications

(the doctor conducting the examination must be told if one of these applies to you)

- Stop taking aspirin or any other anticoagulant treatment at least 7 days before the examination (according to your GP’s advice);
- Recently discovered coronary disease (angina pectoris);
- Recent heart attack;
- Chronic bronchitis or severe emphysema;
- Unstable bronchial asthma;
- Known blood coagulation problems.

Duration

- Between 15 and 30 minutes
- Observation after the examination before a return home is authorised.

Inconveniences

- Injection of a substance to dry out the airways: short-term visual problems, vision may be blurred for 60-120 minutes.
- Do not drive a vehicle for 6 hours (the effects of the sedative may be prolonged).
- It is advisable to remain at home and not to work on that day.

Complications

- Nausea and coughing (during the local anaesthetic)
- Sputum with blood may be seen in the hours following the procedure if biopsies are taken.
- Temperature may be raised, up to 39°, during the 12 hours after the procedure (treat with paracetamol). If the raised temperature lasts for more than 24 hours after the examination, a medical examination will be required (possible infection).

Complications (rare to very rare)

- In patients with hypersensitivity to the local anaesthetic, severe complications, including cardiac arrest, may occur. (Literature describes 2 instances of death in over 50,000 bronchial endoscopies).
- Drastic reduction in blood pressure, cardiac arrhythmia, heart attack, fainting, convulsions, breathing difficulties, infections.
- In cases of peripheral pulmonary biopsy:
- Pneumothorax, which may require admission to hospital.
- Severe haemorrhage has been reported, but is exceptional.

 

What should be done if complications occur?: If complications occur, post-examination observation will be extended and admission to hospital may be necessary. Cardiac problems and severe vagal reactions may require the administration of drugs. If haemorrhage occurs, a coagulant substance may be administered in the bronchus.

 

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