Bronchoscopy

What is a bronchoscopy used for?

• It is routine to look at the airway before the start of thoracic surgery to check for any problems and clear mucous
• Biopsies can be taken
• Foreign objects can be removed
• Extra procedures can be done to unblock or widen the airway. These include dilating (widening) the airway, removing abnormal tissue, or placing a stent.

Sometimes people are very unwell from the airway being very narrow or from bleeding in the airway. Lung tumours can block the airway and cause severe shortness of breath. We may be able to perform a bronchoscopy urgently to help.

What is recovery like?

Most people are admitted on the day of the procedure and usually can go home again later the same day without having any problems. After a general anaesthetic you can feel quite tired. You should not work or drive for 48 hours afterwards. It is normal to have a sore throat after a bronchoscopy, this should settle over a few days. You can use painkillers as usual at home if required.

If you have an extra procedure you may need to stay in hospital overnight for monitoring. If you have a bronchoscopy as an emergency you will need to stay in hospital afterwards for monitoring and recovery.

What are the risks?

The risks here are a guide; your own risk may vary. You should discuss the risks and benefits of surgery with your surgeon, especially if you are worried. Complications after bronchoscopy are uncommon.

If you have severe symptoms and one of the large airways is partly blocked the surgery carries more risk. You should discuss this with your surgeon.

Minor more common risks

You may cough up a small amount for a few days, this is normal. You may need to stay in hospital or have another operation if there is a lot of bleeding. Damage to the teeth, lips or gums is possible. If you had difficulty breathing before the bronchoscopy your oxygen levels may be lower for a few hours or days. You will be monitored until this improves and given medication if necessary.

More serious uncommon risks

It is possible to make a small hole in the airway. Rarely bronchoscopy may cause a pneumothorax, commonly referred to as a collapsed lung, this would make you feel short of breath. You may need to have a chest drain and stay in hospital until it settles. Death is very rare after bronchoscopy if your breathing was not difficult before the surgery.

Extra procedures during bronchoscopy

Biopsy

Small samples of tissue can be taken from inside the airway. This is usually done to confirm the diagnosis of what is causing a lump in the airway.

Dilatation

Dilatation is widening of the airway. A small balloon device is passed into the airway and inflated, this pushes the airway open. Narrowing can come back after dilatation, the procedure can be repeated. Tracheal resection may provide a long-term solution for certain patients with narrowing in the airway.

Removing tissue and laser

Tissue can be removed to clear a blockage. This may be used on its own or in combination with a laser. A laser beam can be used to burn away tissue that is blocking the airway. There is a small amount of bleeding with either of these procedures. Bleeding can normally be stopped during the bronchoscopy. Heavy bleeding is very rare. If there is a lot of bleeding you may need a blood transfusion. If there is damage to a major blood vessel, bleeding could be fatal.

Stents

Stents are tubes that can be placed inside the airway after dilatation. They help prop the airway open and make breathing much easier. They are most commonly used to help manage symptoms of lung cancer. Stents may become displaced or make it difficult to clear mucus from the lungs. Extra tissue may form in reaction to the stent, narrowing the airway again. Very rarely a stent may wear away a section of the airway and damage a blood vessel or the gullet (oesophagus).

What are the alternatives to surgery?

Having a diagnosis can guide which treatments would be best for you. It can also give you an idea of what to expect from the disease, including symptoms or whether the disease may shorten your life.

If you do not want to have a bronchoscopy to get a diagnosis other options may include:

• relying on existing tests (such as scans) to judge which disease is most likely
• repeating a previous test
• continuing close observation

You can discuss treatment options with your hospital doctors, your lung cancer nurse and your GP. If you do not want surgery or are not well enough to have an operation other options may include:

• radiotherapy
• chemotherapy
• palliative care

It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits you. You are always welcome to seek a second opinion.