Bronchoscopy
Bronchoscopy is an examination and treatment procedure that is performed with an endoscope . The method is also called lung endoscopy.
What is a bronchoscopy?
With a bronchoscopy, both medical examinations and therapies are possible. The procedure is also called lung endoscopy and is carried out using an endoscope that enters the body through the mouth or nose . The bronchoscope reaches the bronchi in the lungs via the windpipe (trachea) and enables a thorough analysis.
The first examination and treatment using an optical device was carried out in 1897 by the German laryngologist Gustav Kilian (1860-1921), who is considered the founder of bronchoscopy. In 1966, the Japanese physician Shigeto Ikeda (1925-2001) developed a flexible bronchoscope.
application and function
Bronchoscopy is used to examine and treat bronchial and lung diseases. The people affected suffer from respiratory problems such as persistent coughing or bloody sputum . These symptoms can be caused by respiratory problems such as bacterial or fungal infections , an infection of the lungs (pneumonia), a lung abscess that causes pus to collect in the lungs, or a lung tumor.
Bronchoscopy is one of the most important examination methods, especially in the case of lung cancer. A tissue sample ( biopsy ) can be taken and then subjected to a fine-tissue examination. The tissue sample is taken with small forceps attached to the bronchoscope. Bronchoscopy is also suitable for removing tissue from enlarged lymph nodes. These are located in the mediastinum of the chest cavity.
However, a bronchoscopy is also performed to carry out treatments. In the case of asthma, bronchial secretions can be sucked out like a mucus plug. Lung endoscopy is also suitable for stopping bleeding and removing foreign bodies from the airways.
If a patient is being ventilated, bronchoscopy helps to correctly position the breathing tube. Stents can also be inserted to keep the airways open.
methods and procedures
In bronchoscopy, it is important to distinguish between rigid and flexible bronchoscopy. Rigid bronchoscopy, which is performed under anesthesia, allows for more extensive interventions. It is primarily used for children or persistent pulmonary bleeding. The procedure is also suitable for removing foreign bodies, inserting stents in the trachea and diagnosing lung cancer.
Rigid bronchoscopy has now been largely replaced by flexible bronchoscopy. In most cases, a gentler and more effective examination or treatment of the patient is possible with the more flexible instruments. In addition, no anesthesia is required.
Since the diameter of the flexible bronchoscopes is small at 2 to 3 millimeters, they are also used for children. Their decisive advantage is their lower risk of injury, while they can be inserted deeper than rigid bronchoscopes. Flexible bronchoscopy can take tissue samples, look for lung tumors, diagnose foreign bodies, clarify airway constrictions, correct ventilation hoses or suction out a mucus plug.
In the run-up to a bronchoscopy, the doctor treating you takes X-rays of the chest and an ECG to rule out certain pre-existing conditions. These include an acute heart attack , severe myocardial insufficiency , blood clotting disorders or severe pulmonary dysfunction. It also determines the blood coagulation status.
What does the patient have to consider?
On the day of the bronchoscopy, it is important that the patient refrains from eating and drinking at least four hours before the start of the examination. He also has to give up smoking. The patient is not allowed to eat again until two hours after the bronchoscopy, so that he does not choke due to the anesthetic of the throat .
In addition, drugs with a blood-thinning effect must be discontinued in good time. After the bronchoscopy, the patient should temporarily refrain from driving because he or she will usually be given short-term anesthesia or a sedative.
process and implementation
A bronchoscopy usually takes only 15 to 20 minutes. To make the lungoscopy easier, the doctor usually gives the patient a sleeping pill or a local anesthetic in the form of a spray to suppress the gagging reflex caused by the insertion of the bronchoscope. The patient then positions himself on his back during the examination.
At the beginning of the examination, the doctor inserts the bronchoscope into the patient’s windpipe through the nose or mouth. Once the endoscope has reached the lungs, the mucous membranes of the respiratory tract are examined. The examination can extend to the fourth branch of the bronchi. The patient does not feel any pain. Certain sections can also be flushed through. The rinsing liquid can then be sucked out.
If necessary, the doctor also takes smaller tissue samples from the lungs. In addition, cells or bacteria can be obtained, which are then examined in a laboratory.
The bronchoscope is connected to a camera plus a light source, channels that serve to insert other medical instruments, and access points for suction and rinsing. If necessary, therapeutic measures can also be carried out with the endoscope.
During the bronchoscopy, the patient’s cardiac and respiratory functions are under constant surveillance. It is not uncommon for an X-ray examination of the chest to be carried out after the lung endoscopy in order to counteract the risk of a collapsed lung. In addition, the patient must behave quietly for another 24 hours. Once the examination of the samples taken is complete, the doctor informs the patient which disease he is suffering from and treats him accordingly.
Self-service or health insurance – who will bear the costs?
The health insurance companies cover the costs for a bronchoscopy if a corresponding examination or treatment with a bronchoscope has to be carried out. This can be used, for example, to rule out cancer.
Risks, dangers and complications
Certain risks are also possible when performing a bronchoscopy. There is a risk of coughing , hoarseness , sore throat , difficulty swallowing or nosebleeds due to the mechanical effects of the endoscope . Some patients occasionally experience a transient fever . However, serious side effects from bronchoscopy are extremely rare.
If the doctor takes tissue samples as part of the bronchoscopy, slight bleeding is possible. These can sometimes be so severe that they have to be staunched with an endoscope.
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