Bronchoscopy

This information has been written by staff working in the Endoscopy Unit at Chelsea and Westminster Hospital and West Middlesex Hospital. We hope you find it useful. If, after you have read it, you have any questions or concerns, please contact us:

Chelsea and Westminster Hospital

If you would like to change your appointment time or date, please contact the Endoscopy Unit booking team on 0203 315 3053/5984.

West Middlesex Hospital

Your appointment time in Endoscopy is approximate as some procedures may take longer than expected and emergency procedures need to take priority. Please expect to be in the department for several hours for pre-procedure checks and the procedure.

What is a bronchoscopy?

A flexible bronchoscopy is a procedure where a doctor can look at the trachea (windpipe), the bronchi (branches of the airways) and into some areas of the lungs. In order to do this, the doctor uses a ‘bronchoscope’, which is a long flexible tube, about the width of a thin pencil, with a bright light at the end.

During a bronchoscopy, a bronchoscope is passed through your nose or mouth, past your larynx (voice box), down your trachea (windpipe) and into the bronchi. The images taken by the bronchoscope are projected onto a TV screen and the doctor can look at them to check whether or not any disease is present in your lungs.

Sometimes a biopsy—a sample of tissue—is taken for analysis (testing) in the laboratory. The tissue is removed through the endoscope using tiny forceps. It is also possible to remove polyps during the colonoscopy. Polyps are abnormal growths of tissue, similar to warts that normally should be removed and examined more closely. This is not painful.

There is a considerable variation in the way people react to this procedure and the sedation. General anaesthesia is not required. The procedure is safe but may be unpleasant and, at times, uncomfortable.

If you chose to have sedation, we aim to use enough sedative to relax you. We do not send you to sleep but we will do our best to make you as comfortable as possible. Some people will not remember all of the procedure after having the sedative, this is normal and nothing to worry about.

What should I do before I come in?

If you are having sedation, you must organise for someone to take you home after the test and be with you for 24 hours.

If you are diabetic, please let us know in advance.

Unless advised otherwise, if you are taking any of the following medicines, please contact the nurse or a member of the endoscopy team for further instructions:

• Warfarin, rivaroxaban, apixaban, dabigatran, edoxaban
• Clopidogrel, prasugrel, ticagrelor
• Aspirin or any other medication used to thin the blood (anti-coagulant)

What are the benefits of the procedure?

This procedure helps us to look for disease within your lungs and to assess the extent of any disease.

Potential risks and complications of the procedure

A bronchoscopy is a relatively safe procedure. The chance of having a complication is small. All medical procedures are associated with a degree of risk and hospitals have to tell patients about the potential risks and complications involved, even if the risks are small.

Prior to the test you will be seen by the endoscopist. This is an opportunity to discuss the test before you sign a consent form. Please ask any questions you may have. It is important that you understand what is going to happen.

Minor complications

• Sore throat and hoarse voice: This is due to the bronchoscope rubbing the lining of your throat and should disappear within 48 hours. Drinking plenty of fluids or sucking sweets may help relieve the symptoms.
• Nose bleed or soreness: This is due to the bronchoscope rubbing the lining of the nose and should disappear within 48 hours.
• Slightly blood-stained phlegm: This may occur if biopsies have been taken but should clear up within 24–48 hours. If it continues please contact your hospital doctor.
• Fever, flu-like symptoms or aching across the lungs: These symptoms can occur and last for 24–48 hours. Usually they will settle by taking paracetamol. If these symptoms continue for several days, please contact your hospital doctor as you may have developed a chest infection.
• A drop in your oxygen levels: This can occur during the procedure but does not usually have long-lasting effects. Your levels are constantly monitored during and after the procedure so that additional oxygen can be given if necessary.

Rare complications

A rare complication of this procedure is chest infection. This occurs in less than 1% (1 in 100) of cases.

Very rare complications

Bronchoscopy is a very safe procedure. The chances of a serious complication that results in death are extremely low, and probably below 0.0002% (1 in 500,000).

What will happen during the procedure?

A nurse will stay with you and will monitor you throughout the procedure.

• In the bronchoscopy room you will be made comfortable on a hospital trolley bed in a sitting or lying position.
• The doctor may give you an injection of a sedative into a vein in your arm to make you feel sleepy and relaxed.
• A local anaesthetic will be sprayed in your mouth towards the back of your throat. This numbs your throat and it may feel like you can’t swallow.
• If the bronchoscopy is to be performed through the nose, local anaesthetic jelly will be inserted into your nostrils—this makes it more comfortable to have the bronchoscope tube in your nose.
• As the bronchoscope is passed through your nose or mouth and down the back of the throat, more local anaesthetic will be sprayed onto the larynx (voice box). This may make you cough a little. However, as the local anaesthetic takes effect, your throat will relax, and the coughing should ease. When the bronchoscope enters the lungs, there is no need to worry—there is plenty of room to breathe around it as the tube is very thin.
• During the procedure you will be given extra oxygen through a soft plastic tube placed just inside your nostril. A plastic ‘peg’ will be placed on your finger to monitor your heart rate and oxygen levels throughout the procedure.
• The bronchoscopy usually takes 20–30 minutes to complete.

Other investigations that may be carried out

During the bronchoscopy it may be necessary to have a ‘wash’, bronchoalveolar lavage (BAL), or a biopsy. These are explained below.

‘Wash’ or bronchoalveolar lavage (BAL)

Performing a wash involves passing a small amount of salty water through the bronchoscope into a certain part of the lung and sucking it back out again. The fluid that is sucked back out is sent for laboratory examination. The bronchoalveolar lavage (BAL) is a similar procedure but uses a larger amount of fluid (up to 240mls).

Biopsy

This involves passing a wire down the bronchoscope with a small pincer at the end. The pincer is used to take a tiny piece of lung (biopsy), which is then sent for laboratory examination under a microscope. You should not feel any pain with these biopsies.

There are different types of biopsy—endobronchial, transbronchial, cryobiopsy, and endobronchial ultrasound guided transbronchial fine needle aspiration (EBUS-TBNA).

• Endobronchial (EBB): During this biopsy a small piece of tissue is gently pinched off the surface of the lining of the bronchi. There are few side effects with this biopsy.
• Bronchial brushings: If we see an abnormal airway, we can insert a small brush through the bronchoscope to collect cells for analysis. This is very safe, and not associated with additional side effects.
• Transbronchial: This biopsy is taken from deeper into the lung and carries a higher risk than an EBB (please see ‘Potential risks and complications of the procedure’ above). This type of biopsy still involves gently pinching a small piece of tissue, which is taken from the lung.
• Endobronchial ultrasound guided transbronchial fine needle aspiration (EBUS-TBNA): This procedure uses a special bronchoscope with ultrasound scanning built into it. This allows the area beyond the air passages to be evaluated and samples from lymph glands obtained under ultrasound control.

Tumour ablation

This involves using the bronchoscope to try and remove tumour that is blocking off some of the air passages. The risks of this procedure are greater than a routine bronchoscopy. However, the benefits are also greater, whether the air passages are partly or fully blocked.

Diathermy/electrocautery

This involves using an electrical current to burn and remove tumour from within the airways. Tumours blocking of the airways cause breathing difficulty and can also lead to pneumonia and coughing up blood. This procedure allows the air passage to be re-opened. The main risks of this procedure are that it may trigger worsening of the breathing (respiratory failure), induce low oxygen levels, bleeding, palpitations or cardiac arrhythmias. Occasionally it can also lead to perforation of the airways.

Cryotherapy and cryobiopsies

This procedure involves using a freezing probe on areas of abnormal airway, lung or tumour. The freezing process causes tissue to stick onto the probe and this can then be removed from the airway. Cryobiopsies can be used to obtain small samples of the lung to make a diagnosis. Repeated application can allow the removal of tumours blocking the air passages. Like diathermy, opening up the air passages may lead to improvements in breathing. The main risks of this procedure are that it may trigger of worsening of the breathing (respiratory failure), induce low oxygen levels, an increased risk of bleeding, palpitations or cardiac arrhythmias. Occasionally it can also lead to perforation of the airways.

After the procedure

A nurse will take you to the recovery area in the Endoscopy Unit on your trolley to rest. The effects of the sedative will gradually wear off. This normally takes around 2 hours but varies from person to person. Some people snooze after the test, but you may want to bring a book to read. Until your throat returns to normal, you should not eat or drink anything. You will be given a drink of water about 2 hours after your procedure.

Eating and drinking

After the bronchoscopy you will not be able to eat or drink for about two hours—this is because your throat will still be numb and there is a risk that you could choke on your food or drink. It is not safe to eat or drink until the anaesthetic has worn off and full sensation has returned. The nurses monitoring you will let you know when it is safe to eat and drink again. When you get home, please avoid eating or drinking anything too hot as you may scald your throat.

When you can leave hospital

After the bronchoscopy you will be taken to a recovery area while the sedation wears off. This may take up to 2 hours. When you are sufficiently awake, and can drink safely, you can then go home. You will need to arrange for an adult, such as a relative or friend, to come with you to the department and to take you home.

When you can resume normal activities including work

As you will have been given a sedative you might continue to feel sleepy for the rest of the day. Therefore, it is important that an adult, such as a relative or friend, stays with you for 24 hours after the procedure and that during this time you do not drive, ride a bicycle or operate machinery, perform tasks requiring skill or judgement (including signing official documents or making important emotional or financial decisions), return to work or drink alcohol.

Sedation

Sedation has its own set of effects, separate from the procedure. The length of time you will be under sedation depends on the difficulty of the procedure, and the need for extra investigations such as a biopsy.

• People vary in their response to sedative drugs—some may need higher doses while others need minimal or no sedation.
• There is a possibility that the sedative may not be effective, which means that some people may not feel sleepy or relaxed even when safe high doses are used. Should this be the case the procedure will still go ahead if you are happy for it to do so. You should not feel any more discomfort/pain than if you had responded to the sedation. Sedation often means that you do not have memory of what happened but if the sedation is not effective, it is likely that you will remember the procedure.
• Some people may experience an adverse (bad) reaction to the sedative drugs that are used. These reactions are usually minor but can include rash, nausea, vomiting and fainting due to lowering of blood pressure.

Do I need to be escorted home?

Please ensure the nurses have the contact details for your escort prior to the procedure. A nurse from the unit will call your escort once you are ready for collection.

Please note: You will not be able to have sedation or general anaesthetic if you do not have an escort arranged to collect you. We cannot escort you home.

The sedative will make you drowsy and even if you feel wide awake your reactions may still be affected. You may find it difficult to concentrate and you may forget things that you have been told after the procedure. The nurses will give you written discharge information. This includes the advice that for 24 hours after sedation you should not drive, ride a bicycle, operate machinery, take sedatives, drink alcohol or sign any legally binding documents.

What happens to my medication?

We will talk to you before you go home about any changes/additions to your medication(s).

What can I expect when I go home?

After the bronchoscopy you might cough up a bit of blood. 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.

If you cough up a large amount of blood (half cup) or you have concerns or questions, please contact the Endoscopy Unit from 8am–6pm on :

Outside of these times please call :

*Remember to take your endoscopy report with you*

Will I get the results of my test on the same day?

The full results of the test will not be available until your follow-up outpatient appointment (or during your hospital stay if you are an inpatient), as it can take up to seven days to process the results of biopsies and washes. Your GP will receive a copy of the report of the examination from the hospital.