Clinics in chest medicine
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Stents are used for palliation of symptoms of central airway obstruction caused by either malignant or benign conditions. Stents may be applied for maintaining airway patency after dilatation of postinflammatory and infectious strictures, for airway dehiscence after lung transplantation, and for the management of tracheobronchomalacia. ⋯ Placement of tube stents requires rigid bronchoscopy and dilatation of strictures beforehand, whereas metal stents can be applied using a flexible bronchoscope. Advantages and disadvantages of commonly used airway stents are discussed.
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Over the past century, bronchoscopy has become an essential tool for pulmonologists and thoracic surgeons, who for many years have employed bronchoscopy with such therapeutic modalities as laser therapy, electrocautery, cryotherapy, and stent placement. Over the past decade, advanced imaging techniques, such as autofluoresence bronchoscopy, electromagnetic navigation, narrow-band imaging, confocal fluorescence microendoscopy, and endobronchial ultrasound, have greatly expanded the diagnostic utility of bronchoscopy. This article reviews the technological advances in the field of diagnostic bronchoscopy.
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Prolonged pulmonary parenchymal air leaks are an important clinical problem. Standard treatment of prolonged air leaks include continued chest tube drainage, pleural sclerosis, or surgery. ⋯ The development of bronchial valves for treatment of emphysema allowed the use of these devices for air leaks under compassionate use regulations. Multiple reports of successful bronchial valve treatments, along with the US Food and Drug Administration's (FDA) humanitarian use approval of a bronchial valve for certain postsurgical air leaks, provide new evidence that there is likely a role for endobronchial treatment of prolonged air leaks in selected patients.
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Electromagnetic navigation bronchoscopy using overlaid CT Images is a safe procedure. It improves the diagnostic yield of the flexible bronchoscopy for peripheral lesions and also allows sampling of the mediastinal lymph nodes. ⋯ It can also be used for fiducial marker placement for brachytherapy or stereotactic radiosurgery. It plays a complementary role to other modalities such as ultrathin bronchoscopy or an endobronchial ultrasonography.
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Lung volume reduction surgery has proven benefits in emphysema. However, high postoperative morbidity and stringent selection criteria for suitable candidates are limitations in clinical practice. Endoscopic approaches to lung volume reduction have used a range of different techniques such as endobronchial blockers, airway bypass, endobronchial valves, biologic sealants, and airway implants to address the limitations of surgery. ⋯ Currently available data on efficacy of bronchoscopic lung volume reduction are not consistently conclusive, and subjective benefit in dyspnea scores is a more frequent finding than improvements on spirometry or exercise tolerance. The safety data are more promising, with rare procedure-related mortality, fewer complications than lung volume reduction surgery, and short hospital length of stay. The field of bronchoscopic lung volume reduction continues to evolve as ongoing prospective randomized trials aim to clarify the efficacy data from earlier feasibility and safety studies.