Use of an ultrathin bronchoscope in the assessment of central airway obstruction.
OBJECTIVE
To assess the utility of an ultrathin bronchoscope (UB) in the assessment of central airway obstruction (CAO).


METHODS
Prospective evaluation


METHODS
Tygerberg Hospital, a tertiary teaching hospital.


METHODS
Consecutive patients referred to the Lung Unit with CAO.


METHODS
Fiberoptic bronchoscopy (FOB) was performed with a prototype UB (Olympus BF XP40; Olympus Europe; Hamburg, Germany; outer diameter, 2.8 mm; working channel, 1.2 mm). The UB was used whenever a standard bronchoscope (SB) could not pass the obstruction or could not be tolerated by the patient.


RESULTS
Data relating to indication and performance of FOB, patient demographics, utility in establishing a diagnosis, and planning definitive management were documented. Twenty-four patients (17 men; mean age, 46 years) were studied. Twelve patients (50%) had malignant CAO, 8 patients (33%) had benign tracheal stenosis, 3 patients (12.5%) had stent occlusion, and 1 patient (4%) had bilateral vocal cord paralysis. In 42% of patients, an initial attempt at passing the obstruction with an SB had failed. Vocal cords or trachea were involved in 62% of patients. The mean luminal occlusion was 84% of the total airway lumen (range, 50 to 100%). One complication (desaturation) led to early termination of FOB. In all but three patients with complete obstruction, the UB was able to pass the CAO and allowed assessment of the obstruction and the distal airways (87%).


CONCLUSIONS
UB-FOB was useful and safe in the assessment of patients with CAO from both benign and malignant disease. It aided in establishing a diagnosis and/or planning of definitive management in all patients examined.
Schuurmans
Macé M
MM
Lung Unit, Department of Internal Medicine, University of Stellenbosch, Tygerberg, Cape Town, South Africa. mms2@sun.ac.za
Michaud
Gaëtane C
GC
Diacon
Andreas H
AH
Bolliger
Chris T
CT
D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology*; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies