Pediatric Interventional Bronchoscopy

Removal of foreign bodies from the child’s airways can be done either by a flexible bronchoscope or a rigid bronchoscope.

• Flexible bronchoscopy for foreign body extraction: Most usual foreign bodies like peanuts, almonds, other nuts and seeds can be removed using a flexible bronchoscope. We can use many instruments like baskets, triprongs, rat-tooth forceps etc. The process can be done in mild sedation.
• Rigid bronchoscopy for foreign body extractionSome foreign bodies require a rigid bronchoscopy. Foreign bodies like sharps pins, badly stuck foreign bodies or subglottic (just below the vocal cords) foreign bodies require rigid bronchoscopy. Optical forceps are used for removing foreign bodies. Rigid bronchoscopy is done under general anesthesia.

Removal of foreign bodies from the child’s airways can be done either by a flexible bronchoscope or a rigid bronchoscope.

• Conventional Transbronchial Needle Aspiration (cTBNA): This process involves taking a FNAC sample from lymph nodes of the chest. A needle is passed through the channel of the bronchoscope and passed beyond its tip. The needle is then progressed into the lymph node and sample obtained. The sample is then sent for detailed analysis including cytopathology and microbiology like cultures and genexpert MTB PCR.
• Endobronchial Ultrasound Guided- Transbronchial Needle Aspiration (EBUS-TBNA): This process also involves taking a FNAC sample from lymph nodes of the chest. EBUS-TBNA is done through a special bronchoscope with has an ultrasound probe at its tip. This ultrasound can visualize the lymph node clearly. Once the lymph nodes are located a EBUS needle is passed through the channel of the bronchoscope and passed beyond its tip. The needle is then progressed into the lymph node and sample obtained under ultrasound guidance. The sample is then sent for detailed analysis including cytopathology and microbiology like cultures and genexpert MTB PCR

children with diffuse lung diseases or interstitial lung diseases require to get a lung biopsy for a proper diagnosis. In this process we pass a cryoprobe through the flexible bronchoscope and advance it into a lung segment as shown. The cryoprobe would then freeze a very tiny portion of the lung, which is then removed. The sample of the lung tissue obtained is sent for detailed analysis. Three to five biopsy samples are taken with cryobiopsy. There is a small risk of bleeding and air leak called as pneumothorax.

Whole lung lavageis a process done for children with a condition known as pulmonary alveolar proteinosis.

Children might get a narrowed airway either at the level just below the vocal cords called as subglottis or in the windpipe called as trachea. This is usually caused by a prolonged intubation on a ventilator. This narrowed airway lead to difficulty in breathing and noisy breathing called as stridor. In such cases of subglottic stenosis or tracheal stenosis the narrowed area can be dilated using a balloon passed along side a bronchoscope.

We have also been performing advanced bronchoscopy interventions in children like removal of foreign bodies, transbronchial lung biopsy, lung cryobiopsy, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA), air balloon dilatation and placement of stents in the pediatric airway. The unit also has a facility for performing rigid bronchoscopy in children. Bronchoscopy services are available 24 X 7 in the hospital.