Indications, clinical outcomes and complications of 1,949 flexible bronchoscopies

ABSTRACT Objective To describe indications, clinical outcomes and complications of flexible bronchoscopy. Methods A descriptive observational study of bronchoscopies performed at the endoscopy service of Hospital Israelita Albert Einstein . Demographic (age, gender and origin) and medical (indications and results of endoscopy and diagnostic tests, such as biopsy collection, lavage, cytology and culture) data were analyzed. Electronic medical records with incomplete data or reporting interventional procedures were excluded. Results Over a three-year period (2013 to 2016), a total of 1,949 bronchoscopies were performed by respiratory endoscopy team and anesthesia specialists of the hospital. The mean age of patients was 57.7±21.9 years (range of 3 days to 99 years), with prevalence of males (56.4%). The procedures were mostly (86.3%) elective and 30.7% were carried out in the intensive care unit. Major indications for bronchoscopy were infection or secretion (42.4%), followed by suspected neoplasm (10.8%). Endoscopic changes were reported in 91.9% of cases, with more than one change described in approximately 6.9% of patients. Positive results were obtained via direct testing or culture in 36.3% and 53.9% of 1,399 bronchoalveolar lavages, respectively. The overall diagnostic yield (bronchoalveolar lavage and biopsy) was 72.6%. Mild adverse event rate was 7.2%. The rate of severe adverse events requiring additional intervention was 0.5% (pneumothorax, 0.4%; severe bleeding with patient death, 0.1%). Conclusion Lower airway endoscopy is critical for respiratory disease assessment, diagnosis and treatment. Flexible bronchoscopy is associated with good diagnostic yield and minimal inherent risk.

摘要 研究目的 旨在描述柔性支气管镜检查（flexible bronchoscopy）的适应证、临床结局与并发症。方法 本研究为描述性观察性研究，纳入以色列阿尔伯特·爱因斯坦医院（Hospital Israelita Albert Einstein）内镜中心开展的所有支气管镜检查病例，分析相关人口学数据（年龄、性别与来源）与临床资料，包括检查适应证、内镜检查及诊断检验结果，如活检取材、灌洗、细胞学检查与培养结果。排除数据不完整或记录有介入性操作的电子病历。结果 2013年至2016年的三年间，该院呼吸内镜团队与麻醉专科医师共完成1949例支气管镜检查。患者平均年龄为57.7±21.9岁，年龄范围为3天至99岁，其中男性占比56.4%，为多数群体。检查中86.3%为择期手术，30.7%在重症监护室内开展。支气管镜检查最主要的适应证为感染或分泌物异常（42.4%），其次为疑似肿瘤（10.8%）。91.9%的病例报告存在内镜下改变，约6.9%的患者存在不止一种内镜改变。在1399例支气管肺泡灌洗（bronchoalveolar lavage）病例中，直接检测与培养的阳性率分别为36.3%与53.9%。联合支气管肺泡灌洗与活检的整体诊断检出率为72.6%。轻度不良事件发生率为7.2%。需额外干预的严重不良事件发生率为0.5%，其中气胸占0.4%，伴患者死亡的严重出血占0.1%。结论 下呼吸道内镜检查对于呼吸系统疾病的评估、诊断与治疗至关重要。柔性支气管镜检查具备良好的诊断效能，且固有风险极低。