Bronchoscopic Dilatation

Bronchoscopic dilatation

Bronchoscopic dilatation is a form of minimally invasive surgery performed using a bronchoscope to dilate narrowed and occluded airways (bronchi). It is mostly utilized for treating tracheobronchial stenosis (airway obstruction) due to the following conditions such as post-intubation, tumor, infections and congenital defects. 

Indications

Bronchoscopic dilatation is generally advised in the presence of: 

Benign airway stenosis

• This is scarring that occurs after intubation or tracheostomy.
• Postinfectious scarring 

Airway obstruction- malignant

• Tumors (palliative or pre-surgical) which cause airway narrowing.

Congenital airway abnormalities

• Collapse resulting from tracheomalacia or bronchomalacia. 

External compression of the airways

• Out of lymph nodes, vessels or mediastinal masses.

Advantages

• Less invasive than the open surgical airway reconstruction.
• The relief of airway obstruction symptoms.
• Repeatable, in case of restenosis.

Bronchoscopic balloon dilatation

Bronchoscopic balloon dilatation (BBD) is one of the non-surgical approaches and is done by the transbronchial insertion of a balloon which is subsequently inflated to press the stenotic walls of the tracheobronchial lumen. It is among the most often applied method in benign and certain malignant stenosis of airways.

Bronchoscopic dilatation procedure

Bronchoscopic dilatement is an intervention that involves the enlargement of constricted airways (trachea or bronchi) by mechanical or balloon means through a bronchoscope. It is mostly prescribed to airway stenosis.

Preparation before the procedure

Patient evaluation: 

• History, physical examination and tests of pulmonary functions.
• CT scan or chest X-ray to detect stenosis.
• Fasting: 6–8 hours, sedation/general anaesthesia as a rule. 
• Consent: Risk and benefit description.
• Premedication: Local anaesthesia or sedatives, when necessary.

Anaesthesia

• Flexible bronchoscopy (conscious sedation).
• General anaesthesia (rigid bronchoscopy, severe stenosis or children patients)

Bronchoscope Insertion

• Flexible bronchoscope: nasomastically or orally.
• Rigid bronchoscope: Oral (in more severe cases of stenosis or mechanical dilators are required)
• Airways are scanned in order to determine the length of stenosis, diameter and location.

Dilatation Techniques

Balloon Dilatation (most prevalent)

• The bronchoscope is used to introduce balloon catheter in the narrowed part.
• Balloon slowly blows up as a way of stretching the stenotic airway.
• The inflation lasts 30-60 seconds and can be repeated.
• Balloon is pumped and taken out.

Mechanical Dilators

• Bougies or rigid bronchoscopes can be gently inserted in order to dilate the airway.

Adjunctive Measures

• Obstructing tissue to be removed, laser, electrocautery, or cryotherapy.
• Stenting in the case of airway prone to collapse or restenosis.

Post-dilatation Assessment

• Bronchoscope is again introduced to ensure airway clearance.
• Bleeding, mucosal injury, or trauma.
• Measure change in airway diameter.

Recovery

• Watch for a few hours to 24 hours depending on anaesthesia and the size of the procedure.
• You may experience mild coughing, sore throat or hoarseness. 
• The improvement of symptoms is most often immediate.

Bronchoscopic dilatation recovery

Post-bronchoscopic lasting improvement is generally rapid, as it is a minimally invasive operation. The majority of the patients report an immediate improvement in breathing.

Recovery Post-Procedure 

• 2-6 hour observation in a recovery area.

Monitoring includes:

• Breathing pattern
• Oxygen levels
• Cardiac rate and blood pressure.
• General anaesthetic patients might require more time of observation.

Post-Procedural Activity

• Take rest the rest of the day.
• Recovery should resume normal activity within the 24 hours, unless otherwise.
• Avoid smoking, intense physical activities and heavy lifting within 24 -48 hours.

Eating and Drinking

• Fluids may usually be consumed within 1-2 hours of the procedure when the numbness in the throat has subsided.
• On the first day, soft diet in case of irritation of the throat.

Breathing Improvement

Most patients experience:

• Immediate decompression of obstruction.
• Easier breathing
• Better physical performance or movement.
• In severe or recurrent stenosis cases improvement can however be slow.

Follow-Up

Follow-up is very important:

• Initial review (typically 1-2 weeks).
• Further bronchoscopy can be required to examine re-stenosis.
• In case a stent has been inserted, it needs to be observed periodically.

Long-Term Recovery

• Repeat dilatation may be necessary to some patients depending on the cause of the stenosis.
• Maintenance bronchoscopy is also carried out after every 3 to 6 months in case of a stent.
• Benign stenosis with follow-up care is excellent in terms of long-term outcome.

Bronchoscopic dilatation complications

Bronchoscopic dilatation (balloon or mechanical) is also relatively safe, however, as any airway intervention, it can be risky. Majority of the complications are not serious but are easy to manage with and serious cases are not common.

• Bleeding
• Airway Trauma
• Pneumothorax 
• Bronchospasm
• Hypoxia 
• Infection
• Re-stenosis (Re-narrowing of the Airway)
• Edema (Airway Swelling)

Best hospital for bronchoscopic dilatation India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Bronchoscopic dilatation is a low risk, efficient and minimally invasive procedure of airway stenosis treatment. It is useful as it allows rapid relief of airway obstruction, improves breathing as well as the quality of life by widening narrowed tracheal or bronchial segments with the help of a mechanic or balloon. The surgery is not only tolerated well, it has a short recovery time and can be repeated in case of a need. Even with the complications expressed, including bleeding, airway trauma or restenosis, they can be controlled with the right technique and aftercare. All in all, bronchoscopic dilatation is a useful treatment measure against both benign and malignant airway constriction.

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FAQ

1. Is the procedure painful?

• No. The operation is carried out under sedation or general anaesthesia, so you won’t feel any pain during the procedure. 

2. How long does the procedure take?

• Most dilatation procedures take 20 to 40 minutes and this depending on the location and severity of the stricture. 

3. How soon will I feel better?

• The majority of patients report to have their breathing improved immediately after the procedure.

4. Will the constriction of the airways recur?

• Sometimes, yes. The re-stenosis may also take place particularly in severe or protracted strictures. Repeat dilatation or stenting could be required.

5. Am I required to have a stent following dilatation?

• Not always. The placement of a stent is only possible in case of an unstable airway or in case the constriction recurs.

6. Can this be done for children?

• Yes. Bronchoscopic balloon dilatation is also popular in the cases of airway stenosis in children and is deemed to be safe in the hands of qualified professionals.

7. Is the procedure safe?

• Yes. Bronchoscopic dilatation when done by trained pulmonologists or thoracic surgeons have high success rate with low chances of complication.