Bronchoscopy: Instrument, Indications, and Therapeutic Capabilities

A bronchoscope is a flexible (or rigid) endoscope designed to visualize the tracheobronchial tree. It enables diagnostic evaluation and therapeutic intervention without open surgery.

Types

• Flexible bronchoscope: Fiberoptic or video-chip; diameter 2.8–6.0 mm; used for most diagnostic/therapeutic procedures under moderate sedation.
• Rigid bronchoscope: Metal tube; requires general anaesthesia; used for massive haemorrhage, foreign body removal, stent placement, laser therapy.

Diagnostic Indications

• Unexplained cough, haemoptysis
• Pulmonary infiltrates/nodules (bronchoalveolar lavage, brushings, transbronchial biopsy)
• Lymphadenopathy (endobronchial ultrasound–guided TBNA / EBUS-TBNA)
• Airway inspection for stenosis, fistula, tracheomalacia
• Surveillance post-lung transplant

Therapeutic Procedures

• Foreign body removal
• Airway stent placement (silicone/metallic) for malignant/benign stenosis
• Endobronchial tumour debulking: laser, argon plasma coagulation, electrocautery, cryotherapy
• Balloon dilation of strictures
• Endobronchial valve placement for emphysema
• Bronchial thermoplasty for severe asthma
• Haemostasis (topical agents, argon plasma, balloon tamponade)
• Guided difficult intubation

Safety and Preparation

• Pre-procedure: NPO 6 hrs, coagulation check, informed consent.
• Monitoring: Pulse oximetry, ECG, BP; supplemental O₂.
• Complications (rare): Hypoxaemia, bleeding, pneumothorax, laryngospasm, fever.

Bronchoscopy is a cornerstone of interventional pulmonology, offering minimally invasive diagnosis and treatment of central airway and parenchymal disease.