Diagnostic Yield and Outcome Of Bronchoscopy Unit at Ain Shams University Hospital in Current Clinical Practice (Including Recent Modalities and Interventional Pulmonolgy) Marwa S Daif, Ragy Mamdouh Ghaly Lecturer of Chest Diseases, Lecturer of Ches | ||||
| Ain Shams Medical Journal | ||||
| Volume 75, Issue 1, March 2024, Page 67-79 PDF (851.96 K) | ||||
| Document Type: Review Article | ||||
| DOI: 10.21608/asmj.2024.252938.1187 | ||||
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| Authors | ||||
Marwa S Daif   ; Ragy Mamdouh Ghaly
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| Department of Chest Diseases, Bronchoscopy and Interventional Pulmonology Unit, Faculty of Medicine, Ain-shams University, Egypt. | ||||
| Abstract | ||||
| Background: The field of bronchoscopy and interventional pulmonology was advancing rapidly. minimally invasive approaches were replacing aggressive surgical ones for the diagnosis of chest disease and staging of lung cancer, treatment, and palliative intervention. Recent modalities help in early detection, allow early treatment, ideally influencing patient outcomes and also palliative management of malignant patients to enhance quality of life. These modalities had been introduced with the aim to increase the diagnostic and therapeutic yield of endoscopy; such innovations are limited to specialized centres. Aim of The Work: We aim in this study to assess the diagnostic yield of routine bronchoscopy and interventional pulmonology techniques and its recent modalities, including EBUS, navigation bronchoscopy, and thoracoscopy, also rigid bronchoscopy with therapeutic purpose with percentage of successes and complications with different procedure including type of anaesthesia and interventional pulmonology at bronchoscopy and interventional pulmonology unit at Ain Shams University Hospital. Patient and methods: Prospective cross-sectional study at bronchoscopy and interventional pulmonology unit in chest department of Ain Shams University Hospital from July 2022 to end of July 2023, was carried out on 394 patients attending Ain Shams University Hospital. Where patient undergo preoperative assessment for fibreoptic bronchoscopy including different recent modalities as (EBUS and Navigation Lung Point), rigid bronchoscopy (debulking, tracheal dilatation, foreign body removal, drug instillation and stent insertion) and thoracoscopy, with type of anaesthesia was indicated and intraoperative follow up with postoperative assessment and follow up. All of them were subjected to full history and clinical examination, and monitored regarding their preprocedural investigations, procedure details and sampling techniques, complications, and finally the patients were followed up regarding their histopathological and bacteriological results and follow up, with percentage of success also in therapeutic yield. Results: A total of 394 patients were included, the mean age of all patients was (48 ± 18.4) years. Regarding the patients, (42.1%) females; and (57.9%) males, with (81.7%) in urban areas, and (18.3%) in rural areas. According to Type of Endoscopy, (56.1%) had fibreoptic bronchoscopy, (12.9%) of patients had EBUS, (3.3%) had navigation (lung point), (16.5%) had rigid bronchoscopy, and (11.2%) had thoracoscopy. Diagnostic yield of the fibreoptic bronchoscopy (54.8%) success divided as (28.1%) malignancy, (6.8%) Sarcoid diagnosis, (12.7%) bacterial Pneumonia, (6.8%) Tuberculosis, and (1.8%) fungal diagnosis. While navigation bronchoscopy; (76.9%) success, with (61.5%) malignancy, (7.7%) sarcoid and TB diagnosis. According to the recent intervention EBUS, diagnostic yield (80.4%) success, with (43.1%) malignancy, (25.5%) sarcoid diagnosis, (2%) pneumonia, and (9.8%) tuberculosis diagnosis. Thoracoscopy diagnostic yield (84.1%) as successes with (64.2%) malignancy, (2.3%) bacterial Pneumonia while (13.6%) tuberculosis. Diagnostic yield of rigid Bronchoscopy; (60%) success, with (49.2%) malignancy, (1.5%) sarcoid, (6.2%) bacterial pneumonia, (3.1%) fungal diagnosis, and (1.5%) hydatid diagnosis. Complications during endoscopy which highly significant increase with (patients with previous bronchoscopies, patients who undergo GA, and rigid bronchoscopy), and patient undergo to therapeutic endoscopy group; compared to diagnostic endoscopy group (p < 0.05 respectively). Complication was as intraoperative bleeding, persistent hypoxia, pneumothorax, tachycardia, hypertension, laryngospasm and bronchospasm presenting 7.6 % in all patients. Regarding all types of endoscopies; (93.4%) diagnostic endoscopy group, and (19.5 %) therapeutic endoscopy group. So, regarding diagnostic interventions, (28.9%) of patients had bronchial biopsies, (61.9%) had bronchial lavage, (42.9%) had bronchoalveolar lavage, (22.1%) had TBNA, and (26.9%) had pleural biopsy. Therapeutic endoscopic interventions; (4.1%) of patients had debulking, (2%) had stent insertion, and (0.5%) had tracheal dilatation, foreign body removal 5%, drug instillation 7.9%. Conclusion: Routine bronchoscopy with recent modalities technique is a perfect diagnostic yield in current clinical practice. The procedure is more useful in diagnosis when combined with a new modality introduced to increase the diagnostic yield of bronchoscopy, which is limited to specialized centres as EBUS and navigational technique, also rigid bronchoscopy and thoracoscopy as diagnostic and therapeutic intervention. In real practice on real ground in short time with achievement of the significant advances in the field of advanced bronchoscopy and to put them into clinical context with less complications and better safety with current diagnostic challenges. | ||||
| Keywords | ||||
| Bronchoscopy; EBUS; Navigation; Tuberculosis; Sarcoidosis; Malignancy | ||||
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