A bronchoscopy is a medical procedure that uses a thin, flexible tube called a bronchoscope to visually examine the airways and lungs. Equipped with a light and camera, the bronchoscope allows a pulmonologist to diagnose, evaluate, and treat various lung conditions. Bronchoscopies are generally considered very safe when performed by trained specialists, and the procedure is typically done on an outpatient basis. Like all medical interventions, it carries risks, but serious complications are rare.
Common and Minor Side Effects
Most patients experience temporary side effects resulting from the procedure or the medications used. A sore throat and hoarseness are common because the bronchoscope passes through the vocal cords, but these symptoms usually resolve within 24 hours. Local anesthetic causes numbness in the mouth and throat, which suppresses the gag reflex. Patients must wait until this sensation returns before eating or drinking. Other minor effects include a temporary cough, blood-streaked sputum (especially if a tissue sample was collected), or a low-grade fever.
Identifying the Major Complications
Although the procedure is safe overall, the risk profile includes a few major complications. The most frequently cited serious risk is bleeding, particularly when a transbronchial biopsy is performed to collect tissue. While minor bleeding is common, severe hemorrhage requiring intervention occurs in a very low percentage of cases. A pneumothorax, or collapsed lung, is another rare complication that can happen if the airway wall is injured. This is most often associated with aggressive sampling techniques like transbronchial biopsy. Infection, such as pneumonia, can occur, especially in patients with pre-existing conditions that compromise their immune system or lung function. Reactions to sedation medication, including respiratory depression or cardiac arrhythmias, are also potential complications.
Patient Factors That Increase Risk
The risk of a major complication is often influenced by the patient’s underlying health status. Patients with severe lung diseases, such as advanced Chronic Obstructive Pulmonary Disease (COPD), face a higher risk of respiratory complications. The procedure can temporarily worsen oxygen levels, which is dangerous for those with already compromised breathing. Conditions affecting the heart, such as a recent heart attack or unstable angina, also elevate the risk of cardiac complications. Patients with uncorrectable blood clotting disorders face a significantly higher risk of severe bleeding, especially if a biopsy is planned. For these individuals, the medical team must take additional precautions. Low oxygen levels (hypoxemia) or high levels of carbon dioxide (hypercapnia) before the procedure also increase the likelihood of complications. Other factors, like anemia or the need for the procedure to be performed in an intensive care setting, are also associated with increased risk.
Ensuring Safety During and After the Procedure
Preparation and Monitoring
Safety for a bronchoscopy begins well before the procedure day with careful patient preparation. Patients are instructed to fast for several hours beforehand to prevent aspiration. If the patient is taking blood-thinning medications, they will be advised to temporarily stop or adjust the dosage in the days leading up to the procedure to minimize bleeding risk.
During the bronchoscopy, the medical team continuously monitors the patient’s oxygen saturation, heart rate, and blood pressure. Supplemental oxygen is administered throughout the procedure to counteract any temporary drop in oxygen levels. This close monitoring allows the team to respond immediately to any signs of a complication.
Recovery
After the bronchoscope is removed, patients are observed in a recovery area for several hours. The team watches for the return of the gag reflex and checks for early signs of bleeding or difficulty breathing. Patients are given specific discharge instructions, including when to seek immediate medical attention for symptoms like chest pain, persistent fever, or coughing up more than a small amount of blood.