It consists of a long system of flexible or rigid tubes equipped with a light source and a camera. The image from them is displayed on the monitor, and it is possible to record it. The method has proven itself not only as diagnostic; it can also be used to perform some therapeutic procedures.

You will learn about whether preparation for the study is necessary, the methodology for conducting it, as well as the indications and contraindications for this manipulation in our article. But first, we bring to your attention a short historical background and information regarding the types of bronchoscopes.

History of bronchoscopy

The first such study was carried out at the end of the 19th century. Its goal was to remove a foreign body from the tracheobronchial tree. And since both the device and the manipulation technique were imperfect, in order to reduce pain and reduce the risk of injury and complications, the patient was injected with cocaine.

Only more than half a century later, in 1956, a device that was safe for subjects was invented - a rigid bronchoscope. And 12 years later, in 1968, a flexible modification of this device appeared. Subsequently, the research technique was improved, and today the doctor has the opportunity to observe on the monitor screen a many times enlarged image of the mucous membrane of the respiratory tract, and the patient can remain conscious during the procedure and experience virtually no discomfort.

Bronchoscopes: types, advantages

There are 2 types of bronchoscopes: fiber-optic bronchoscope (or flexible) and rigid bronchoscope. It cannot be said that one of them is better and the other is worse. Each of the devices is used in certain situations and has its own advantages over its counterpart.

Fiber bronchoscope

It is a smooth, thin, long tube equipped with a light source and a video camera. If necessary, a catheter and some instruments can be inserted into the patient's bronchi through this tube.

It is used primarily for the purpose of diagnosing the condition of the mucous membrane of the trachea and bronchi; it can also be used as a means of removing foreign bodies of small diameter from the respiratory tract.

The main advantage of a flexible bronchoscope is that the risk of injury to the mucous membrane of the respiratory tract when using it is minimal. In addition, due to its small diameter, it penetrates into remote sections of the bronchi and can even be used in pediatrics. The procedure using it does not require putting the patient under anesthesia; often only local application of an anesthetic is sufficient.

Rigid bronchoscope

This device consists of several hollow rigid tubes connected to each other. Their diameter is larger than that of a fiber-optic bronchoscope, so this device does not penetrate into small bronchi. It is also equipped with a photo or video camera, a light source and many devices that allow a number of medical procedures to be carried out during bronchoscopy.

It is used not only for diagnosis, but also for therapeutic manipulation. Using it you can:

• rinse the bronchi with an antiseptic solution, inject an antibiotic, hormonal or other drug into their lumen;
• remove foreign body and viscous sputum from the bronchial tree;
• stop bleeding;
• excise the tumor, scar, that is, restore the functionality of the bronchi;
• normalize bronchial patency by installing a stent.

If, when using a rigid bronchoscope, there is a need to examine bronchi of a smaller diameter, a fiber bronchoscope can be inserted through its tube and the diagnosis can be continued.

This manipulation is performed under general anesthesia (or general anesthesia) - the patient is in a state of sleep and does not experience discomfort associated with the study.

Indications for bronchoscopy

This diagnostic method is used to clarify the diagnosis in the following clinical situations:

• if the patient has an unmotivated persistent cough;
• if the patient has shortness of breath of unknown etiology (when the most common causes - COPD, bronchial asthma, chronic heart failure - are excluded);
• with hemoptysis (blood with sputum);
• if there is a suspicion of the presence of a foreign body in the bronchi;
• if a neoplasm is suspected in the lumen of the tracheobronchial tree or lung cancer, as well as to determine the boundaries of the spread of lung cancer along the bronchi;
• if the fact of a long-term inflammatory process has been established, the nature of which could not be previously clarified;
• in case of recurrent pneumonia in the patient’s history (in order to find their cause and eliminate it);
• when a chest x-ray reveals dissemination syndrome (multiple foci (suspicious tuberculosis), cavities or cysts in the lungs);
• for the purpose of taking the contents of the bronchi to determine the sensitivity of its microflora to antibiotics;
• when preparing a patient for lung surgery.

Contraindications for the study

• stenosis (narrowing of the lumen) of the upper respiratory tract II-III degree;
• bronchial asthma in the acute stage;
• severe respiratory failure;
• stroke or myocardial infarction suffered by the patient within the last 6 months;
• aneurysm (sac-like expansion) of the aorta;
• severe arrhythmias;
• severe hypertension;
• pathology of the blood coagulation system;
• individual hypersensitivity to anesthetic drugs;
• diseases of the neuropsychic sphere, in particular epilepsy, severe head injury, schizophrenia and others.

Carrying out bronchoscopy for any of the above conditions is accompanied by a high risk of complications and aggravation of the patient’s condition until death.

This manipulation should also be delayed during the period of acute respiratory viral infection, in the first phase of the menstrual cycle, and in the third trimester of pregnancy.

It is worth noting that in each specific case, even if there are contraindications, the doctor determines individually whether to perform bronchoscopy or not. If the situation is an emergency and the patient could die without this procedure, the doctor will likely perform it, but will be alert to possible complications and will take steps to prevent them.

Is preparation necessary for the study?

Bronchoscopy is an invasive procedure that requires careful preparation for its implementation (this will help increase the information content of the study and reduce the risk of complications).

First of all, the patient must be carefully examined. The required minimum is:

• general blood test;
• blood sugar test;
• blood test for coagulation (coagulogram);
• determination of blood gas composition;
• X-ray of the chest organs.

So, based on the data obtained, the doctor will determine whether there are contraindications to the study and, if there are none, he will tell the patient about how the bronchoscopy will proceed and how the patient should behave during the procedure.

The patient, in turn, is obliged to notify the doctor about his existing chronic diseases of the heart, endocrine and other organs, about his history of allergic reactions (it is very advisable to know what exactly he was allergic to and how it manifested itself), about the medications he is taking permanently (you will probably have to stop taking some of them temporarily).

• It is important to perform the procedure on an empty stomach, so the patient should not eat for at least 8 hours before the bronchoscopy. This will minimize the risk of food getting into the trachea and bronchi.
• On the day of the study you should stop smoking.
• During bronchoscopy, the patient's intestines must be emptied. To achieve this, on the day of the study, in the morning, he will have to do a cleansing enema or use suppositories (suppositories) with a laxative effect.
• To prevent the patient from having to go to the toilet during the diagnostic process, it is necessary to empty the bladder before starting the diagnostic process.
• If the subject shows excessive anxiety, he may be given sedatives. For the same purpose, the doctor can prescribe tranquilizers and sleeping pills the day before - the patient should be calm and well rested during the procedure.
• After bronchoscopy, the patient may experience short-term hemoptysis, so he should have a towel or napkins with him.

Bronchoscopy technique

Bronchoscopy is performed in a room specially designed for this purpose in compliance with all sterility rules.

• At the preparatory stage, the patient is administered a drug that dilates the bronchi (Salbutamol, Atropine or others) by inhalation or by subcutaneous injection. This will ensure easy passage of the bronchoscope through the airway.
• The pharyngeal mucosa is treated with a local anesthetic (usually a lidocaine solution is used), which suppresses the gag and cough reflexes, which will allow the doctor to easily insert the tube. At the same time, the patient feels numbness in the palate, as if he has a lump in his throat, his nose is slightly stuffy and it becomes difficult to swallow saliva. If you plan to use a rigid bronchoscope or the procedure is performed on a child or a weakened patient, an anesthetic drug is administered inhalation or intravenously. As a result of its action, the person falls asleep and does not feel anything during the entire procedure.
• During the examination, the patient sits or lies on his back.
• As the doctor inserts the bronchoscope into the airway, the patient is asked to breathe quickly and shallowly (this type of breathing minimizes the risk of a gag reflex).
• The route of insertion of the tube is through any nostril or through the mouth.
• When the tube reaches the glottis, the patient takes a deep breath and at its height, the doctor moves the bronchoscope deeper with rotational movements.
• During the examination, the doctor alternately examines the mucous membrane of the larynx, glottis, trachea, bronchi until the second branch. The bronchi located more distally have too small a diameter, so they are not accessible to research. As the tube moves through the airway, the patient may feel slight pressure in different parts of the airway. The bronchoscope does not interfere with breathing.
• If necessary, the doctor can use special instruments to take a piece of material from the bronchi or their mucous membrane for examination, rinse them with an antiseptic or antibiotic solution, and even remove the polyp.

What's next?

• After the study is completed, the patient is recommended to remain under the supervision of medical personnel for at least an hour.
• He should not eat or smoke for 2 hours - this can cause bleeding.
• If the patient took sedatives before bronchoscopy, he should not drive a vehicle for 8 hours after taking them. This is due to the fact that the above drugs often cause drowsiness and reduce reaction speed, which means that the risk of an accident increases sharply.

Are there any complications?

In some cases, complications arise during bronchoscopy. The lion's share of them consists of bleeding (the result of injury to the mucous membrane) or an infectious process (due to non-compliance with the rules of asepsis and antisepsis). Their main clinical manifestations are as follows:

• incessant hemoptysis;
• high body temperature, chills;
• chest pain;
• wheezing heard at a distance;
• nausea, vomiting.

If at least one of these symptoms occurs, you should not waste time; it is important to consult a doctor as soon as possible.

Also complications of bronchoscopy are pneumothorax, mediastinal emphysema (if a lung biopsy was performed through the bronchus), cardiac arrhythmias, hypoxia (in people with insufficient heart and lung function), bronchospasm (in patients suffering from bronchial asthma). These conditions do not develop in a delayed manner, but are noticeable immediately and require emergency medical care for the patient.

What is virtual bronchoscopy

Virtual bronchoscopy is a type of X-ray examination, a variant of computed tomography, the result of which, using a special program, is converted into a three-dimensional picture of the tracheobronchial tree. The undoubted advantage of this research method is its non-invasiveness (there is no risk of injury to the mucous membrane or the development of bleeding). However, for many reasons, it cannot replace classical bronchoscopy: it is exclusively diagnostic and is used only in certain clinical situations (in particular, for the purpose of diagnosing bronchial tumors and monitoring the rate and nature of their growth). Virtual bronchoscopy, of course, does not allow therapeutic manipulations.

Conclusion

Bronchoscopy is a therapeutic and diagnostic invasive procedure that allows the doctor to examine the mucous membranes of the tracheobronchial tree, verify the diagnosis and carry out some manipulations (rinse the bronchi with a drug solution, take a wash or a piece of tissue for examination, dilate the bronchi, excise a scar or tumor, and so on). It is carried out after a comprehensive examination and careful preparation of the patient, taking into account contraindications. In some cases, complications arise after bronchoscopy, usually associated with trauma to the wall of the organ being examined or the penetration of pathogenic microorganisms into this area.

The risk of complications compared to the diagnostic and therapeutic value of the procedure is negligible. Sometimes only bronchoscopy allows you to verify the diagnosis, and therefore is the key to proper treatment. You should not be afraid of this test, but you should follow your doctor’s recommendations as much as possible regarding preparation for it.

Which doctor should I contact?

Bronchoscopy is performed by an endoscopist. It is referred by a pulmonologist, surgeon or oncologist. Before performing this manipulation, it is recommended to consult a therapist, and for elderly patients, a cardiologist.

Practicing physician Anna Maslennikova talks about preparing for bronchoscopy and how the study is carried out:

Help the children

Useful information

Contact the specialists

Phone number for appointments with medical specialists in Moscow:

The information is provided for informational purposes only. Do not self-medicate. At the first signs of illness, consult a doctor.

Editorial address: Moscow, 3rd Frunzenskaya st., 26

Bronchoscopy. How is bronchoscopy performed? Types and indications for bronchoscopy

What is bronchoscopy?

How is bronchoscopy done?

The human lower respiratory tract consists of the trachea, the main ( right and left) bronchi and bronchial tree. The trachea or windpipe is divided into the right and left main bronchus. Secondary bronchi depart from them, which, in turn, are divided into small branches, and those into even smaller ones. The set of all secondary bronchi and their branches is called the bronchial tree. Thus, conditionally, the lower respiratory tract can be expressed as follows. Trachea – left and right main bronchus – secondary bronchi – bronchial tree. During bronchoscopy, the fiberscope examines the trachea, main and secondary bronchi, then it passes into the middle and small branches of the bronchi. However, the fiberscope cannot penetrate the smallest bronchioles due to their small diameter. To study smaller branches, other diagnostic methods are used, for example, virtual bronchoscopy.

Bronchoscopy method

Preparation for bronchoscopy and procedure

• conducting medical examinations;
• preliminary medical consultation;
• psychological preparation of the patient;
• maintaining a special diet;
• taking sedatives;
• performing a series of actions immediately before the procedure.

Conducting medical examinations

• X-ray of the lungs. To get a picture of the lungs ( radiography), a beam of X-rays is passed through the chest and then imaged on film. Since bones absorb radiation, they appear white in the image, while air cavities appear black. Soft tissues are indicated in gray on x-rays. Based on the image, the doctor sees the location of pathological foci and subsequently pays special attention to them during bronchoscopy.
• Cardiogram. The examination is carried out in order to obtain a graphical display of the work of the heart. Special electrodes are installed on the patient's chest, arms and legs, which monitor the heart rhythm and transmit it to a computer, where the data is compiled into a cardiogram. In order for the examination to be as informative as possible, the patient should not eat 2–3 hours before the procedure. Using the cardiogram, the doctor determines whether there is a risk of negative consequences for the heart during bronchoscopy.
• Blood test. To exclude the possibility of infectious processes and other diseases that may interfere with bronchoscopy, the patient is prescribed blood tests. For biochemical analysis, blood is taken from a vein, for general analysis - from a finger or also from a vein. For the results to be reliable, the analysis must be performed on an empty stomach, which requires not eating 8 hours before the procedure. It is also recommended to give up alcohol and fatty foods for 1–2 days.
• Coagulogram. To conduct this study, blood is taken from the patient's vein, which is then tested for clotting. A coagulogram is prescribed to eliminate the risk of bleeding during and after bronchoscopy. As with other blood tests, the patient must not eat 8 hours before the procedure and not consume alcoholic beverages or high-fat foods for 1–2 days.

Preliminary medical consultation

After receiving data on all prescribed preliminary examinations, the patient is sent to a doctor who will perform bronchoscopy. Before the procedure, a preliminary consultation is indicated, during which the patient will be explained what he needs to do before and after the lung examination. A person who is indicated for bronchoscopy must inform the doctor whether he is taking any medications, whether he suffers from allergies, or whether he has previously undergone anesthesia. This information will help the doctor choose the optimal procedure for the patient.

The emotional state has a great influence on the quality of bronchoscopy and the results obtained. During the procedure, the patient should be relaxed and calm, since otherwise it will be difficult for the doctor to carry out the necessary manipulations with the bronchoscope. The best way to help the patient calm down is to become familiar with all aspects of the procedure. To get a complete picture of how bronchoscopy is performed, the patient should, during the preliminary consultation, ask the doctor all the questions that concern him. The duration of the procedure, the nature of the sensations before and after bronchoscopy, the type of planned anesthesia - these and other questions that the patient may have must be discussed with the doctor.

Following a special diet before bronchoscopy

• any legumes;
• all varieties of cabbage;
• radish, turnip, radish;
• mushrooms, artichokes;
• apples, pears, peaches;
• milk and any products made from it;
• all drinks that contain gases.

A prerequisite is to abstain from any alcoholic beverages the day before bronchoscopy. On the day of the examination, you need to stop smoking, as using tobacco products increases the risk of complications. You should also not drink coffee, cocoa or any caffeinated drinks.

To reduce anxiety, most patients are prescribed sedatives before bronchoscopy ( calming) actions. These medications should be taken in the evening, the day before the examination. In some cases, repeated use of sedatives is indicated, 1 – 2 hours before the procedure.

Before the bronchoscopy, the patient must visit the toilet to empty the bladder. If a person has jewelry on the neck or on such parts of the body as the nose, tongue, lips, they must be removed, as they will prevent the doctor from carrying out the necessary manipulations. The bronchoscope can be obstructed by braces and other devices that are attached to the teeth, so if possible, these should also be removed.

Bronchoscopy results

• catarrhal endobronchitis - characterized only by redness and swelling of the bronchial mucosa;
• atrophic endobronchitis - manifested by thinning and dryness of the mucous membrane, but at the same time the cartilaginous pattern is enhanced;
• hypertrophic endobronchitis - characterized by thickening of the mucosa, which leads to a uniform narrowing of the lumen of the bronchi;
• purulent endobronchitis - the main symptom is purulent discharge accumulating in the lumen of the bronchi;
• fibrous-ulcerative endobronchitis - characterized by the formation of ulcerative lesions on the mucosa, which are subsequently replaced by fibrous tissue.

With the exception of certain cases ( cancer, fistulas and foreign bodies) Bronchoscopy diagnoses inflammatory changes in the bronchi. To evaluate them, the doctor carefully examines the mucous membrane through a fiberscope, or rather, through a camera connected to it. As a rule, the data obtained during bronchoscopy is transmitted to a video monitor. The image obtained on the screen gives a more complete assessment of the mucous membrane. Also, no less important, it can be enlarged several times and get a more detailed image. In order to accurately assess the nature of the inflammatory lesion, the doctor can take a piece of the mucous membrane for further study in the laboratory. This procedure is called a biopsy.

Types of bronchoscopy

• therapeutic bronchoscopy;
• diagnostic bronchoscopy;
• virtual bronchoscopy.

Therapeutic bronchoscopy of the lungs

• lavage of the bronchial tree;
• washing and draining the purulent cavity;
• removal of foreign bodies - most often in children;
• clearing airway blockages that may be caused by mucus or pus;
• treatment of fistulas.

Also, therapeutic bronchoscopy can be performed to stop bronchial bleeding or to administer drugs directly into the bronchial cavity. The last maneuver is usually performed in the treatment of bronchial asthma.

• heart defects;
• second and third degree arterial hypertension;
• serious condition of the patient;
• exudative pleurisy;
• aortic aneurysm;
• pathology of the larynx ( for example, tuberculosis);
• mediastinal tumors.

At the same time, the doctor must take into account both indications and contraindications. For example, if a patient has a foreign object in the respiratory tract, then bronchoscopy will be performed anyway, since otherwise it will be fatal.

Diagnostic bronchoscopy

• suspected lung cancer;
• hemoptysis;
• obstructive pulmonary disease;
• tuberculosis;
• persistent, prolonged cough;
• pathological changes in lung tissue that were identified on x-ray;
• smoking for more than 5 years;
• decline ( atelectasis) lung.

However, as with therapeutic bronchoscopy, there are contraindications for diagnostic bronchoscopy. As a rule, they are limited to pathologies of the heart and blood vessels. This is explained by the fact that during bronchoscopy, blood pressure rises sharply, which can complicate existing pathologies.

• exacerbation of bronchial asthma;
• recent myocardial infarction;
• heart rhythm disturbances in the form of blockade or arrhythmia;
• heart failure or pulmonary failure;
• mental and neurological diseases, such as epilepsy;
• condition after traumatic brain injury.

Diagnostic bronchoscopy is performed, as well as therapeutic one. A mandatory item is anesthesia, which allows you to weaken the muscles of the bronchi, eliminate the cough reflex and eliminate pain in the patient. After preliminary anesthesia and correct positioning of the patient ( he lies on his back) a fiberscope is inserted through the oral cavity into the larynx. Then, with smooth movements, it is pushed into the trachea, and from it into the left or right bronchus.

Virtual bronchoscopy

The diagnostic value is lower than with conventional bronchoscopy - it is not possible to take a biopsy ( piece of material for research).

Highly informative - virtual bronchoscopy allows you to see small caliber bronchi, from 1 to 2 millimeters.

The procedure cannot be carried out for therapeutic purposes, that is, it is impossible to pull out a foreign object or eliminate bleeding.

Much fewer contraindications. Contraindications include only third-degree obesity and pregnancy.

The cost of the procedure is 2–3 times higher than conventional bronchoscopy.

Virtual bronchoscopy is limited in case of claustrophobia ( fear of closed spaces) and early childhood.

Does not require special preparation, duration is from 5 to 15 minutes ( the usual procedure takes about 30 minutes or more).

When performing virtual bronchoscopy, the patient receives a certain dose of radiation.

Even seriously ill patients can be diagnosed.

Bronchoscopy in children

Indications for bronchoscopy in children

• developmental anomalies of the bronchopulmonary system;
• pulmonary atelectasis ( a pathology in which the lung ceases to participate in gas exchange);
• cystic fibrosis ( disease of mucus-producing organs, including the lungs);
• lung abscess ( the formation of a cavity filled with pus in the lung);
• expectoration of blood and/or pulmonary hemorrhage;
• neoplasms in the lungs;
• bronchial asthma ( chronic inflammation of the respiratory system);
• diseases of the lungs and bronchi of unknown origin.

Preparing a child for bronchoscopy

Features of bronchoscopy in children

Indications for bronchoscopy

Bronchoscopy for tuberculosis

Bronchoscopy for lung cancer

Bronchoscopy for bronchial asthma

If a child suffers from bronchial asthma, opinions on the advisability of bronchoscopy are divided. A number of experts classify this endoscopic procedure as mandatory, since it can be used to perform various highly effective manipulations. Others rarely resort to bronchoscopy, as they consider it unsafe for young children with this disease.

Indications for bronchoscopy for bronchial asthma

• lack of results from previous treatment;
• copious mucus secretion, when there is a high probability of developing bronchial obstruction;
• coughing up purulent contents;
• convergence and compression of the pulmonary walls, as a result of which air disappears from the lung bubbles and the organ is switched off from gas exchange.

Therapeutic bronchoscopy is performed to eliminate bronchial obstruction, as well as to reduce the inflammatory process by exposing the mucous membrane to various drugs. In some patients, lavage is performed using a bronchoscope, followed by suctioning of the contents.

Features of bronchoscopy for asthma

Consequences and complications of bronchoscopy

Typically, patients complain of difficulties that arise in the process of swallowing, the sensation of a foreign body in the throat, and numbness of the pharynx. In some cases, after the procedure, small blood clots may be present in the coughed up mucus. Blood appears because during bronchoscopy the device injures the mucous membrane of the respiratory tract. Also, some patients have temporary nasal congestion. To reduce discomfort and prevent the development of more serious complications, people should follow certain rules after bronchoscopy.

• You should not eat or drink water until the effect of the anesthetic wears off ( The doctor will tell you the exact time);
• while the anesthesia continues to act, saliva should be spat out and not swallowed, because otherwise the patient may choke;
• You should stop smoking for 24 hours after the procedure;
• before the first meal, you need to take a small sip of water to check whether the sensitivity of the pharynx has been restored;
• the patient is not recommended to drive until the end of the day;
• During the day after bronchoscopy, it is prohibited to drink any alcohol or hot drinks;
• Ice cream and other types of cold foods/drinks should not be consumed for the next 24 hours.

Complications of bronchoscopy

It should be noted that an allergic reaction to anesthesia occurs in rare cases, and the direct presence of a doctor can quickly normalize the patient’s condition. Another cause of complications during the procedure may be damaged blood vessels, which causes bleeding. The likelihood of bleeding is highest when a biopsy is performed during bronchoscopy ( pinch off a fragment of the lung or bronchi with forceps).

• Pneumothorax. With this pathology in the pleural cavity ( space under the outer lining of the lungs) air appears, which compresses the lung, as a result of which the organ ceases to participate in the breathing process. This complication develops due to damage to the pleura by the bronchoscope or forceps used to perform the biopsy. Pneumothorax is manifested by sharp pain in the chest, which becomes stronger with inspiration and can radiate to the shoulder. The patient's breathing becomes rapid and shallow, and a dry cough is possible. The heart rate quickens, sweat appears on the skin, and general weakness develops.
• Bacteremia. If there is an infectious process in the respiratory tract and damage to the integrity of the bronchi during the procedure, infectious agents enter the blood and bacteremia develops. This pathology manifests itself with such symptoms as chills, nausea, vomiting, general weakness and apathy.
• Perforation of the bronchial wall. It is one of the rarest complications and occurs when various sharp objects are removed from the patient’s respiratory tract ( wire, nails, pins). Symptoms of a violation of the integrity of the bronchi are coughing, expectoration of blood ( not always), severe chest pain.
• Inflammation of the bronchi and lungs. When an infection enters the respiratory tract, the patient may develop complications such as bronchitis and pneumonia. Signs of inflammation include chest pain, fever, and cough.

Prices for bronchoscopy

• Method of carrying out the procedure. Thus, a standard endoscopic examination costs significantly less than a virtual one ( computer) bronchoscopy. In the case of conventional bronchoscopy, the price may also vary depending on which device ( hard or flexible) research is being carried out.
• Institution. The location of the clinic, namely its distance from the city center or from public transport stops, sometimes plays a large role in determining the cost of this procedure. Also influenced by the quality of equipment, the competence of specialists and other factors that determine the prestige of a medical institution.
• Additional manipulations. The cost of the anesthesia used may determine the price of the bronchoscopy. In most cases, a procedure using local anesthetics will cost the patient less. Additional manipulations also include performing a biopsy and subsequent cytological examination.

On average, the cost of a standard bronchoscopy varies from 2,000 to 6,000 rubles. The price of virtual bronchoscopy can reach 7,000 – 9,000 rubles. In some institutions, the price of such a procedure exceeds the average value several times. So, in the capital's European Medical Center on Shchepkina Street, bronchoscopy costs rubles. The difference in price is explained by the foreign equipment that the center is equipped with and other factors that emphasize the prestige and professionalism of the clinic.

For the convenience of Internet users, catalog websites have been created that provide detailed information about various clinics specializing in this procedure. In addition to the address and operating hours, many resources also indicate the approximate cost of the procedure, which allows you to choose the best option with minimal time costs.

Prices for bronchoscopy in Moscow and other Russian cities

Clinic "Be Healthy"

Komsomolsky Prospekt, 28

Medical center "MEDLUX"

Sirenevy Boulevard, 32a

Center "Best Clinic"

Nizhnyaya Krasnoselskaya street, building 15/17

Clinic "Admiralty Shipyards"

Sadovaya street, house 126

Research Institute of Oncology named after Petrov

Pesochny village, Leningradskaya street, house 68

Clinic named after Peter the Great

Piskarevsky prospect, house 47

Almita Medical Center

Zheleznodorozhnaya street, building 12/1

Medical Center "A"

Rimsky-Korsakov street, building 19

Vokzalnaya Magistral street, building 16

Orenburgsky tract, house 138

Marshal Chuikov street, building 54

Maternity hospital No. 16

Gagarina street, house 54

Emergency Hospital

Batyrskaya street, house 39/2

Clinic of the Bashkir State Medical University

Shafieva street, building 2

Republican Hospital named after Kuvatov

Dostoevsky street, house 132

Bronchoscopy is one of the most informative instrumental methods for examining the tracheobronchial tree, which allows not only to establish a diagnosis, but also, if necessary, to carry out a number of therapeutic measures (sanitation, removal of a foreign body, taking swabs, etc.). Before performing bronchoscopy without fail An X-ray examination or CT scan of the chest organs is performed.

Bronchofibroscopy allows with accuracy above 97% diagnose lung cancer, pneumonia of any type, chronic bronchitis and other diseases of the respiratory system.

In the diagnostic department of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow, you can perform a bronchoscopy at any time convenient for the patient at an affordable price. Important: endoscopy of the lungs, bronchi or trachea must be performed by an experienced specialist in conditions equipped with advanced anesthesia and diagnostic equipment. This way, the patient can count on the absence of discomfort and guaranteed informative results.

Indications and contraindications for the procedure

Endoscopic examination of the lungs and other organs of the respiratory system is indicated in the following cases:

• For removing small objects from the respiratory tract.
• To expand the respiratory lumen.
• To remove small tumors.
• To ensure the ability to take a sample of material for biopsy.
• To cleanse the respiratory tract (in case of accumulation of mucus, pus, etc.)
• For administration of medicinal solutions.

Preparation

Before endoscopic examination of the tracheobronchial tree, radiography and CT of the chest organs are mandatory for patients of both sexes.

Carrying out

Endoscopic examination of the lungs and other organs of the respiratory system is carried out as follows:

• The patient is given drugs that have a bronchodilator effect to facilitate passage of the bronchoscope.
• The patient is seated in a special chair equipped with advanced anesthesia equipment.
• Anesthesia of the larynx and vocal cords is performed.
• The bronchoscope is inserted during a deep breath. Further, its passage through the respiratory tract is performed with careful rotational movements.
• During the examination, necessary manipulations can be performed - treating organs with medicinal solutions, collecting material for a biopsy, etc.
• After the examination, the bronchoscope is carefully removed, after which the patient is not recommended to eat or shop for 2 hours.

Bronchoscopy as a method of diagnosis

Indications for the procedure

The study is prescribed in exceptional cases to identify the causes of problems with the respiratory tract. So, it is recommended to carry it out in the following situations:

• causeless persistent cough for a long time;
• bloody traces in coughed up sputum;
• suspected pulmonary infections;
• nodules, compactions or inflammatory processes in the respiratory organs identified during fluoroscopy.

Also, bronchoscopy of the lungs is necessary to remove foreign bodies from the respiratory tract and remove tumors that block the normal flow of air. If part of the lungs is compressed by the tumor, then during this procedure a stent can be installed.

With the help of such diagnostics, it is possible to detect lung cancer - this is one of the most accurate methods for determining this disease, along with computed tomography. But during the examination, the doctor has the opportunity not only to examine the mucous membrane of all bronchi, but also to take suspicious areas for histology.

Evolution of bronchoscopy

It is noteworthy that this procedure has been performed by doctors for more than 100 years. The first bronchoscopy of the lungs was performed back in 1897. But this research became safe only after 1956, when a rigid model of a bronchoscope was created. Another 12 years later, a fiber-optic bronchoscope was developed. This flexible device, designed for pulmonary endoscopy, was created from fiber optics. And 10 years later, the electronic bronchoscope was invented. Since that time, doctors have been able to not only receive a high-precision image on the screen, but also enlarge it, and also store the resulting images.

Currently, during the procedure it is possible not only to diagnose a number of diseases, but also to spray the necessary medications, suck out bronchial secretions, perform a biopsy or remove a foreign body.

Preparation rules

If you are recommended to undergo an endoscopic examination of the respiratory tract, then you need to prepare for it. First, it is advisable to find out how bronchoscopy of the lungs is done. Particular attention should be paid to the rules of preparation for the procedure.

The examination is carried out only on an empty stomach - the period of fasting before it should be at least 6 hours, but it is better to abstain from eating for 12 hours. Also, you should not drink in the morning before the examination. Doctors usually advise taking a sedative pill the evening before the upcoming procedure. Before the bronchoscopy itself, on the recommendation of the doctor, a repeated dose of sedatives may be prescribed. This is necessary for particularly emotional patients.

Conducting a survey

Regardless of the reasons why you were prescribed the procedure, it begins the same way. Therefore, anyone who has already encountered such a study can tell you how bronchoscopy of the lungs is done. Three specialists take part in the process: an endoscopist, an assistant and an anesthesiologist. Initially, the cavity of the pharynx and mouth is anesthetized. This is necessary not only to reduce discomfort, but also to suppress the cough reflex. The anesthetic is sprayed locally using a special device. The patient’s condition is constantly monitored: medical staff monitors pulse, blood pressure and oxygen levels in the body.

Bronchoscopy for lung cancer can be performed sitting or lying down, depending on the doctor’s opinion. The endoscope is inserted through the nose or mouth. The procedure itself lasts from several minutes to an hour. The exact time of its implementation depends on the goals that the doctor has. He may perform certain medical procedures, take a biopsy, or simply examine the surface of the respiratory tract.

If the patient is sitting during the procedure, he should slightly tilt his torso forward and lower his hands between his legs. At the same time, you need to tilt your head back. If a fiberoptic bronchoscope is used, a nasal examination is most often performed. But when using a rigid bronchoscope, the procedure is done only through the mouth.

Possible consequences

After all medical procedures are completed, it is advisable for the patient to remain in the hospital for another couple of hours. During this period, the effect of anesthetic and sedative drugs wears off. Most people who have experienced how lung bronchoscopy is performed say that for 24 hours after the procedure they have a constant desire to cough.

You can eat only after the effect of painkillers has completely worn off. It is advisable to eat food in small portions without any restrictions in the choice of foods. However, doctors advise to refrain from drinking alcohol on the first day.

Common Fears

Most often, people are afraid that pulmonary bronchoscopy is too painful a procedure. In fact, the airways contain virtually no nerve endings, so there is no need to worry. The main problem is suppression of the cough and gag reflex when passing the endoscope through the throat.

One of the common fears is the fear that breathing will be completely blocked during the procedure. But the diameter of the bronchoscope tube is smaller than the lumen of the bronchi, so it will not block the passage for air. In some cases, if necessary, doctors additionally supply the body with oxygen.

Also, many are afraid that they will be harmed during the procedure. Currently, with modern technology, this is simply impossible. Of course, some people experience increased coughing and streaks of blood in their sputum, but this is just a side effect of the procedure. It can last for a couple of days.

Possible discomfort

If you have been prescribed bronchoscopy for pulmonary tuberculosis, then you need to be prepared in advance that this is not the most pleasant procedure in your life. But nothing terrible will happen. After pain relief, everyone feels a feeling of numbness. Many also note some nasal congestion. First of all, the tongue becomes numb, followed by the palate, and a lump appears in the throat, which can cause discomfort when swallowing saliva. No obvious painful sensations should be expected.

Even if you undergo a biopsy, you will not notice it. Problems are possible if the patient cannot relax and does not listen to the doctor’s instructions.

Examination of babies

As a rule, the procedure is performed under local anesthesia. But in some cases, complete immobilization of the patient is necessary. Bronchoscopy of the lungs is often performed this way in children, to whom it is still difficult to explain that they need to sit without moving for quite a long time. In addition, not all children will allow a tube to be inserted into them. Therefore, the anesthesiologist puts them into a state of medicinal sleep using safe drugs.

The procedure is done on an empty stomach, and the bladder and rectum should be empty. Doctors prepare more carefully for such examinations. Suction is taken in advance to remove vomit. Also, just in case, they keep a ventilator nearby. Children are allowed to drink and eat no earlier than 3 hours after the end of the study.

An important argument when choosing pain relief serve the technical capabilities of the medical institution. Bronchoscopy under anesthesia requires a team of four people, including a qualified anesthesiologist (it is often more difficult to administer anesthesia during bronchoscopy than during surgery). Bronchoscopy under local anesthesia is performed by a doctor and a bronchology nurse.

For bronchoscopy under anesthesia in an outpatient setting there are no fundamental contraindications, but appropriate conditions are necessary: ​​a team, equipment, the ability to observe the patient for several hours after the end of bronchoscopy, and, if necessary, to hospitalize.

The procedure itself bronchoscopy under anesthesia, of course, is more humane, but a painful cough after the patient awakens and muscle pain, which sometimes does not allow the patient to get out of bed, reduce the benefits of general anesthesia.

If using telescopic optics eliminates the possibility of examining the bronchial tree with both methods of anesthesia, then for performing a biopsy in some cases, for example from the left upper lobe bronchus, anesthesia provides better conditions due to the greater possibility of straightening the angles of the bronchi. Thus, I.A. Stadnitskaya (1966) considers anesthesia especially indicated when examining the bronchi of the left lung.

Spontaneous breathing allows you to better differentiate the limitation of bronchial mobility. This argument in favor of local anesthesia can be countered by the possibility of restoring breathing during subanesthesia bronchoscopy. But with therapeutic bronchoscopy, maintaining contact with the patient and the possibility of coughing allows for better removal of the contents of purulent cavities into which the aspirator tip does not penetrate.
The listed arguments in favor of both methods pain relief do not exhaust all the advantages and disadvantages of local anesthesia and anesthesia.

In general terms we think expedient When choosing pain relief in bronchological practice, be guided by the following principles:
1. In a modern thoracic surgical department, it is necessary to be fluent in the methods of local anesthesia and anesthesia during bronchoscopy, strictly individually choosing the method of anesthesia for each study;
2. In scientific pulmonology centers, pain relief techniques for bronchological studies should be tested and improved;

3. In medical institutions that do not have anesthesia departments (therapeutic hospitals, anti-tuberculosis dispensaries), as well as in outpatient settings, the method of choice for bronchoscopy should be local anesthesia;

4. If there are indications for bronchoscopy in a surgical department that does not have experience in bronchological work, it is advisable to perform bronchoscopy by an anesthesiologist under anesthesia (intubation experience will help the anesthesiologist to insert a bronchoscope);

5. Bronchoscopy under anesthesia should be performed only with a special respiratory bronchoscope, since when using conventional bronchoscope models, examination under anesthesia loses all its advantages and becomes unsafe;

6. Pulmonary specialization and training of bronchologists create optimal conditions for ensuring the effectiveness and safety of diagnostic studies.

Content

Respiratory diseases are considered one of the most dangerous ailments of our time. In hospitals, a special method is used to examine the bronchi and trachea - bronchoscopy. This procedure is sometimes called tracheobronchoscopy. Timely diagnosis of the tracheobronchial tree helps to avoid the development of many diseases.

What is bronchoscopy

Bronchoscopy or fibrobronchoscopy (FBS) is usually called a method of visual examination of the bronchi and mucous membranes. A biopsy of the respiratory system is performed using an endoscopic examination. Fiberoptic bronchoscopy is also used to obtain samples of secretions from the lungs.

During the procedure, doctors use a special device – a bronchoscope.

It provides direct access to:

• larynx;
• trachea;
• its bifurcation (division into 2 main bronchi);
• bronchi.

Indications

Bronchoscopy refers to invasive research methods, which implies the possibility of violating the external barriers of the body. During the procedure, the patient's mucous membrane, skin or blood vessels may be damaged. For this reason, FBS is allowed only as prescribed by a doctor. Indications for fibrobronchoscopy are:

1. Tumor of the bronchi.
2. Pathological processes on x-ray.
3. Suspicion of the presence of a foreign body.
4. Lung surgery.
5. Collection of contents for flora analysis.
6. Swelling of the trachea.
7. Recurrent pneumonia.
8. Bronchial asthma.
9. Heart failure.
10. Cysts and abscesses in the lungs.
11. Hemoptysis or severe shortness of breath.
12. Chronic inflammation of the bronchi.
13. Tuberculosis.
14. Cystic fibrosis.
15. Lung cancer.

Contraindications

Bronchoscopy is contraindicated in:

• arrhythmias;
• hypertension;
• acute myocardial infarction;
• attacks of suffocation;
• severe bronchospasm;
• blood clotting disorders;
• severe anemia;
• allergies to lidocaine;
• hemorrhagic diathesis.

Types of bronchoscopes

A modern bronchoscope is a hollow tube with a light source attached to the end. The device comes in two types - rigid and flexible.

The first option is a more outdated version, it is used only under anesthesia. A rigid bronchoscope is used in the following cases:

1. Bronchial lavage.
2. Administration of medicinal solutions.
3. Elimination of bleeding.
4. Removing foreign bodies from the lungs.
5. Search for lesions in the respiratory system.
6. Removal of tumors and scars.
7. Dilation and contraction of the bronchi.

Main elements of the device:

• aspirators;
• laser equipment;
• set of grippers and tongs;
• video or photographic equipment;
• manipulator for managing promotion.

A flexible bronchoscope is much safer and more convenient, and therefore causes less discomfort to the patient.

The device is able to penetrate the lower sections of the bronchi without injuring them. Due to the small diameter of the tubes, this type of equipment is often used in pediatrics. The procedure with a fiberoptic bronchoscope is performed without anesthesia. Components of the device:

• catheter;
• control handle;
• surgical and ultrasound equipment;
• optical system;
• controlled manipulator;
• optical cable;
• light guide

A flexible bronchoscope is used:

1. When removing small foreign bodies.
2. For diagnosing the lower sections of the bronchi or trachea.
3. During visualization of the mucous membrane of the respiratory tract.

Preparation for the procedure

Preparation for bronchoscopy is an important stage of the procedure. Some patients are prescribed additional tests before diagnosis, which may include:

• X-ray of the lungs;
• electrocardiography;
• blood test;
• coagulogram.

It is important to promptly inform your doctor if you have allergies, chronic diseases, or are taking medications. All of the information listed can have a direct impact on preparation for the procedure. Experts recommend taking tranquilizers the day before bronchoscopy. This will help relieve anxiety.

The examination is carried out on an empty stomach.

Smoking is prohibited on the day of bronchoscopy. It is mandatory to have a bowel movement before visiting the hospital. For these purposes, you can use glycerin suppositories or an enema.

Bronchoscopy in children causes unpleasant associations. It is better not to reveal all the details of the procedure to your child to avoid a negative reaction. The examination takes place under general anesthesia, so children do not need to know all the intricacies of the process.

If the baby is very nervous, it is allowed to administer mild sedatives.

How is bronchoscopy done?

The procedure is performed in an endoscopy room with a high level of sterility. Fiberoptic bronchoscopy is performed by a doctor trained in bronchial examination. Depending on the type of equipment used, local anesthesia or general anesthesia is used. The procedure is carried out in several stages:

1. To ensure smooth advancement of the bronchoscope, the doctor administers bronchodilators. For example, Euphilin, Atropine sulfate, Salbutamol.
2. The patient must assume a sitting or supine position so that the device can easily penetrate the airway. It is forbidden to bend your chest or extend your head, as this can be traumatic.
3. To suppress the gag reflex when inserting a bronchoscope, it is recommended to breathe frequently and shallowly.
4. The device is inserted through the mouth or nostril during a deep breath. The diameter of the tube is much thinner than the respiratory tract, so the equipment easily penetrates the bronchi.
5. During the examination, discomfort may occur, but there should not be any painful sensations.
6. The examination begins with the glottis and larynx, then moves to the bronchi and trachea.
7. During the procedure, the specialist can perform a number of additional actions: take a piece of tissue for a biopsy, rinse the bronchi with a medicinal solution, and remove samples for further study.
8. Upon completion of the procedure, patients experience a feeling of numbness for half an hour.

Under anesthesia

At the preparation stage, the doctor determines which type of anesthesia is preferable for the patient. Bronchoscopy under anesthesia is indicated when using rigid equipment. Not all people are able to endure the pain of inserting a bronchoscope, and local anesthesia is ineffective in such situations.

Under anesthesia, the patient will feel absolutely nothing.

Under local anesthesia

This type of anesthesia is carried out using a 2-5% lidocaine solution. The drug causes the following reactions in patients:

• numbness of the palate;
• feeling of a lump in the throat;
• difficulty swallowing;
• mild nasal congestion.

Local anesthesia helps to successfully suppress the gag and cough reflex. The bronchoscope is introduced gradually, spraying with an anesthetic spray at each stage. First, the doctor irrigates the mucous membrane of the larynx, then goes lower to the vocal cords. Next, using screwing movements, the specialist advances the device to the bronchi and trachea.

What to do after bronchoscopy

According to doctors, following the recommendations below will help avoid complications:

1. It is not recommended to eat for 2 hours after bronchoscopy.
2. Smoking is allowed no earlier than 24 hours after FBS.
3. You should refrain from driving for 8 hours after the examination if the patient was taking sedatives.
4. To eliminate the risk of bleeding, it is recommended to spend a couple of hours in the hospital under the supervision of medical staff.

Possible complications

Bronchoscopy is considered a safe procedure for human health. However, any research carries a risk of complications. The patient's condition may worsen both during and after the procedure. The most common complications are:

1. Inflammation of the bronchi and lungs.
2. Pneumothorax.
3. Perforation of the bronchial wall.
4. Bronchial spasm.
5. Allergic reaction to sedatives.

There are many factors that influence the occurrence of complications. These include not only medical errors, but also patients’ neglect of specialist recommendations. In order to avoid health problems, it is important to follow your doctor's instructions before and after bronchoscopy. If complications occur, you should immediately seek medical help.

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