Bronchoscopy

What is “Bronchoscopy”?

A bronchoscopy is a procedure that allows your pulmonologist doctor to look at the trachea (windpipe), the bronchi (branches of the airways) and into some areas of the lungs through a thin, long, tube, about the width of a pen called a bronchoscope. The tip of the endoscope has a small camera with light source, which transmits the image to a video monitor. During the bronchoscopy test, a bronchoscope is passed up through your nose or mouth, past your larynx (voice box) down your trachea and into the bronchi.

The doctor will take some samples of any mucus or other secretions found in the airways for laboratories for analysis. Sometimes it is required to take a biopsy (small piece of tissue) of lung (TBLB) or airways (EBB) or needle aspiration of glands in chest (TBNA) which is sent to the laboratory for analysis. This is done by passing small instruments called forceps or needle through the bronchoscope.

There are two types of bronchoscopes: flexible and rigid bronchoscopy. Flexible bronchoscopy done with a flexible pipe, is the most common type of bronchoscopy, as it allows for a more detailed examination of the airways with less discomfort and risk than rigid bronchoscopy. Rigid bronchoscopy is done with rigid metal pipe in especially when a complex therapeutic intervention is planned.

Why is it done? (Indications for Bronchoscopy)

Bronchoscopy can be a diagnostic and therapeutic procedure. This procedure is called diagnostic when it used to help us to check (diagnose) whether or not any disease is present in your respiratory (breathing) system such as lung cancer, infections, inflammation, or bleeding (hemoptysis). This procedure is called therapeutic when the pulmonologist doctor intervenes in the airways with an intent to treat e.g, foreign body, mucus plugs extraction, or removing any central airway obstruction due to cancer or putting an airway stent.

How to prepare for the Bronchoscopy test?

Before your appointment

  • You should remind the medical staff looking after you if you have bleeding problems or take blood-thinning medicine, such as aspirin/clopidogrel/ warfarin, as their dose may need to be adjusted
  • You should remind the medical staff looking after you if you are taking any medicines, especially for hypertension or diabetes (insulin)
  • You should tell your doctors if you are allergic to any medicines, including anesthetic.

On the day

  • You will be asked not to eat or drink for four to six hours before your appointment
  • All your regular medications will be given as normal with a little water
  • You will be bought to the Endoscopy suite, which is at the ground floor of Max Super Speciality Hospital (West Block)
  • When you arrive in the department there may be a delay before your procedure so bring something to read or do to help pass the time

What is the Procedure of Bronchoscopy? How is Bronchoscopy done?

  • In the examination room you will be made comfortable on bed in semi-errect or lying down position
  • A nurse will place a cannula into a vein on your hand/ arm so as to give a sleeping injection to make you feel sleepy and relaxed. You may remember a little about what happened but often you will remember nothing
  • A local anaesthetic will be sprayed into your mouth to the back of your throat. This numbs your throat.
  • Local anaesthetic jelly is inserted into your nostrils; this makes it more pleasant to have the tube in your nose.
  • As the bronchoscope is passed through your nose, some more local anaesthetic to numb the larynx (voice box) is given. This may make you cough a little. As the local anaesthetic takes effect, your throat will relax.
  • You may be given extra oxygen by putting a soft plastic tube just inside your nostril. A plastic ‘peg’ will be placed on your finger to monitor your pulse and oxygen levels
  • The doctor may also insert sterile normal saline, tiny instruments (forceps, needle) through the bronchoscope to collect samples and do biopsy. The biopsy (TBLB, EBB) and TBNA test is completely painless
  • The bronchoscopy usually takes fifteen to twenty minutes, but it may take longer, depending upon what is found and what is done during the test
  • Some patients may be given a sedative or general anesthesia to minimize discomfort and help them relax.

What happens after the Bronchoscopy?

  • After the bronchoscopy you might have a slight nosebleed. If some biopsies have been taken, you might find some streaks of blood in your phlegm. This is quite normal and will usually stop within 24 hours.
  • If you have any soreness in the throat or a hoarse voice, this is quite normal and usually gets better within a day or so.
  • Eating and drinking: If your throat was numbed before the test, you will be advised not to eat or drink for about two hours after the bronchoscopy, because your throat will still be numb. It is not safe to eat or drink until full sensation has returned.
  • After the bronchoscopy, you will be taken to a recovery area while the sedation wears off. When you are sufficiently awake, you will be sent to the ward, this may be up to an hour following the examination
  • If you are discharged from hospital within 24 hours of your procedure you are advised not to drive, operate machinery, return to work, drink alcohol or sign any legally binding documents. You are also advised to have a responsible adult stay with you for the next 12 hours.
  • Check-ups and results: If no biopsy is done doctor will be able to tell you your result immediately after the bronchoscopy as soon as you are awake from sedation. If a biopsy is taken, doctor won’t be able to give you a final opinion for a few days until the tissue has been processed in our laboratories.
  • You should inform the medical staff, if you have excessive bleeding with cough, difficulty breathing or chest pain or any complications after the bronchoscopy procedure.

What are the risks & complication of bronchoscopy?

  • Having a bronchoscopy is a relatively safe procedure. The chance of having a complication is small. Vast majority of patients have an uneventful procedure and recovery. Complications are extremely rare and not all the ones listed below are applicable to one individual.
  • Occasionally, major bleeding (less than 1 in 1000) can occur from the biopsied area which may require further stay in hospital for observation.
  • If you have had a lung biopsy, there is a small risk of leakage of air from the lung (Pneumothorax/collapsed lung).
  • Patients who need to have this type of biopsy may stay in hospital for monitoring and have a chest X-ray. In a small proportion of these patients, we might need to insert a chest drain (a tube) to remove the unwanted air in the chest.
  • Side effects of sedation include effects on heart rate, blood pressure and oxygen saturation in blood. All these parameters are constantly monitored throughout the bronchoscopy procedure. Appropriate measures will be taken immediately, if any abnormality arises.
  • Other minor side effects include sore throat or hoarseness and rarely infection and breathing difficulties, allergic reactions to medications used during the bronchoscopy procedure

If you have any concerns about your lung health or are experiencing respiratory symptoms, talk to your lung doctor about whether a bronchoscopy may be appropriate procedure for you or not.

What is the Bronchoscopy test price?

The bronchoscopy test price varies based on depending upon type bronchoscopy procedure, whether it is diagnostic procedure or therapeutic procedure. Bronchoscopy test price also varies from various places in India. In Delhi NCR itself Bronchoscopy cost is different  with different bronchoscopy test prize range. Usually a basic diagnostic Fiberoptic Bronchoscopy procedure (including Bronchoalveolar Lavage, BAL) cost ranges from Rs10000 to 20000, but in case a biopsy, conventional transbronchial needle aspiration (TBNA) is done then the bronchoscopy test price, cost increases and can go upto Rs 50,000.

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