Is a Bronchoscopy Dangerous? Risks and Safety

Bronchoscopy is one of the safest invasive procedures in pulmonary medicine, with a death rate below 0.1% for both flexible and rigid approaches.¹ That number, while not zero, is comparable to many routine procedures performed under sedation. Complications do happen, and certain patients face higher odds than others, but the overall track record is reassuring enough that bronchoscopy remains a frontline diagnostic tool worldwide.

How Often Complications Actually Occur

A large study comparing elderly and younger adults found an overall complication rate of about 2.3%, with no meaningful difference between the two age groups.² A UK-wide survey covering roughly 60,000 flexible bronchoscopies recorded 27 deaths, yielding a mortality rate of 0.045%. Most of those patients already had advanced lung cancer or serious heart or lung disease beforehand.³ In other words, the procedure itself is rarely what causes the worst outcomes. Pre-existing illness is almost always a contributing factor when something goes seriously wrong.

That said, the risk is not evenly distributed. A straightforward inspection of the airways carries far less risk than a biopsy. And the type of biopsy, the location it targets, the patient’s underlying health, and the medications they take all shift the odds. Understanding which complications are common and which are vanishingly rare helps you have a more grounded conversation with your doctor before the scope goes in.

Bleeding During and After the Procedure

Some bleeding is expected whenever tissue is sampled, but serious hemorrhage during flexible bronchoscopy is rare and usually stops on its own.⁴ Life-threatening bleeding can occur, though, especially during transbronchial biopsies where a small piece of lung tissue is clipped from deeper in the airways. Among biopsy locations, the left upper lobe and the bronchus intermedius carry a higher bleeding risk.⁵

If significant bleeding does occur, bronchoscopy teams have well-rehearsed countermeasures. They can wedge the scope into the bleeding segment to apply pressure, position you so the affected lung is lower than the other (preventing blood from flooding the healthy side), and deliver medications that constrict blood vessels locally. Balloon tamponade and calling in a resuscitation team are reserved for the rare cases where those first steps are not enough.⁴

Pneumothorax Risk With Biopsies

If you are having a simple visual inspection or a wash (bronchoalveolar lavage), pneumothorax is essentially a non-issue. The risk becomes relevant when tissue samples are taken from deeper lung tissue through a transbronchial biopsy. One retrospective study found that about 15% of patients undergoing transbronchial biopsy had some radiographic sign of pneumothorax afterward, but only about 4% needed a chest tube to resolve it.⁶ That 15% figure sounds alarming until you realize it includes tiny air leaks visible only on X-ray that resolve without treatment.

Where the biopsy is taken matters a great deal. Sampling from the left upper lobe roughly doubles or triples the odds of pneumothorax compared to other locations.⁷ The right lower lobe, by contrast, appears to be a safer biopsy site. Other factors that raise the risk include a lower body mass index and having more than four tissue samples taken during a single procedure.⁷ If your lung disease is diffuse and the doctor has a choice about where to biopsy, these numbers may guide them toward a lower-risk location.

Fever and Infection After Bronchoscopy

A mild fever within 24 hours of the procedure is not unusual. In one study, about 14% of patients spiked a fever after bronchoscopy, but only around 3.5% of those were found to have an actual bacterial infection.⁸ The rest had what is sometimes called a “transient bacteremia response,” where the body reacts to the scope and the lavage fluid without developing a true infection. This distinction matters for you practically: a low-grade fever the evening after your bronchoscopy is generally expected and does not mean something went wrong. A fever that persists beyond 24 hours, or that comes with worsening cough, chest pain, or chills, warrants a call to your care team.

What Sedation Adds to the Risk

Most flexible bronchoscopies in many countries are performed under moderate sedation, though the practice is not universal. Some regions do not recommend sedation at all because of concerns about respiratory depression.⁹ The worry is that sedatives can blunt your breathing drive, leading to drops in blood oxygen (hypoxia).

A study of over 2,500 patients found that roughly 22% experienced some degree of hypoxia during sedated bronchoscopy. The strongest predictors were age over 60, reduced lung function on pre-procedure testing, and sedation lasting more than 40 minutes.¹⁰ That 22% figure covers any dip in oxygen levels, not just dangerous drops; most are transient and corrected quickly with supplemental oxygen.

A meta-analysis of randomized trials found that when supplemental oxygen was routinely given alongside sedation, blood oxygen levels were no different than in unsedated patients. Without supplemental oxygen, sedated patients did show measurably lower levels. Severe hypoxia rates, however, did not differ between sedated and unsedated groups overall.¹¹ The practical lesson: sedation is safe as long as you are receiving supplemental oxygen, which is standard practice at most centers.

Flexible Versus Rigid Bronchoscopy

The thin, bendable scope (flexible bronchoscopy) is used for the vast majority of diagnostic work. Rigid bronchoscopy uses a straight metal tube under general anesthesia and is reserved for specific situations like removing large foreign bodies or treating airway obstructions. In a head-to-head comparison for foreign body removal in children, the overall complication rates were similar, but flexible bronchoscopy had a significantly lower risk of desaturation during the procedure.¹²

Older comparative data found that rigid bronchoscopy under general anesthesia carried a higher total number of major complications from diagnostic maneuvers through the scope, while flexible bronchoscopy had more complications tied to the topical anesthetic used to numb the airway.¹³ For most patients, the choice between the two is made by the clinical situation rather than by preference, but if you are told you need rigid bronchoscopy, it is worth understanding that the slightly higher complication profile reflects the more complex problems it is used to treat.

Interventional Bronchoscopy and Stent Placement

Therapeutic bronchoscopy for cancer-related airway obstruction is a different category of risk than a standard diagnostic scope. These patients are often in poor general condition, sometimes already in respiratory failure. Despite that, procedure-related mortality ranges from roughly 0.4% to 1.3%, and the overall severe complication rate is about 4% to 18%.¹⁴ Urgent and emergency procedures, patients with high illness-severity scores, repeat therapeutic bronchoscopies, and the use of moderate sedation instead of general anesthesia were all associated with higher complication rates.

Late complications are a unique concern with stent placement. Granulation tissue can grow into the stent over time, mucus plugs can block it, and the stent can migrate from its original position. These problems may require follow-up procedures weeks or months later.¹⁴

EBUS-Guided Biopsies

Endobronchial ultrasound (EBUS) is a specialized technique where an ultrasound probe at the scope’s tip guides a needle into lymph nodes or masses next to the airways. The largest published retrospective study, covering over 7,300 patients, reported a complication rate of 1.23%. Hemorrhage was the most frequent problem, occurring in about 0.7% of cases. Infectious complications (including rare cases of mediastinitis and sepsis) occurred in about 0.2%, and pneumothorax was exceedingly rare at 0.03%.¹⁵ One death from a severe stroke was reported in that survey. A narrative review spanning both prospective and retrospective data confirms complication rates ranging from well under 1% to around 17% depending on the study design and definitions used, with the largest prospective study finding about 1.4%.¹⁶

When EBUS is performed under conscious sedation directed by the bronchoscopist, about 6% of patients experienced some complication, but the majority were minor and self-limiting. Major complications such as respiratory failure requiring ventilation, heart rhythm abnormalities, or significant drops in blood pressure occurred in roughly 1% of patients.¹⁷

Higher-Risk Groups

People with chronic obstructive pulmonary disease (COPD) face a meaningfully higher complication rate. One study reported about 13% minor and 5% major complications among COPD patients overall, with no deaths. Respiratory complications were about four times more common in those with severe to very severe COPD compared with patients who did not have the disease.¹⁸ A systematic review and meta-analysis confirmed that more advanced COPD staging and higher body mass index were both associated with more frequent complications.¹⁹

Cardiac arrhythmias during bronchoscopy are another concern, particularly for people with underlying heart conditions. Minor rhythm disturbances are common and clinically meaningless, but major arrhythmias have been observed in roughly 11% of patients in one older study. All were self-limited and did not affect blood pressure, but they correlated with drops in oxygen levels during the procedure. This link between hypoxia and arrhythmia risk is why continuous oxygen monitoring throughout bronchoscopy is standard practice.

Bronchoscopy in Children

Pediatric bronchoscopy has its own risk profile. In one tertiary-center study, complications during the procedure included oxygen desaturation in about a quarter of cases, fever in 11%, and bleeding in 3%.²⁰ After the procedure, cough was the most common issue, occurring in about 14% of children. No deaths occurred in that series.

A larger study spanning hundreds of procedures found intraprocedural complications in about 7% of cases, again with low oxygen levels being the most frequent. Post-procedure events were more common at roughly 26%, though most were mild (transient fever and temporary need for supplemental oxygen). Being under two years old nearly doubled the odds of any complication and more than doubled the odds of a severe one. Underlying heart disease was another independent risk factor for serious problems.²¹ Preoperative pulmonary disease or the need for breathing support before the procedure, along with a history of a prior failed rigid bronchoscopy, were both tied to postoperative adverse events and longer hospital stays.²²

Blood Thinners and Bronchoscopy

If you take blood thinners, your doctor will have a plan for managing them before the procedure. The evidence on aspirin alone is reassuring: multiple studies have found no increased bleeding risk with aspirin, and the recommendation is generally not to stop it before bronchoscopy.²³ Clopidogrel (another antiplatelet drug) is a different story. Though small studies suggest it may be safe for low-bleeding-risk procedures like EBUS needle aspiration, the standard recommendation is to stop it about seven days before elective bronchoscopy.²⁴

Warfarin and the newer oral anticoagulants (like apixaban and rivarelbaan) should be held before the procedure as well. The timing depends on which drug you take, how well your kidneys work, and how high your risk of a blood clot is during the gap off the medication. Some patients will need a “bridging” strategy with injectable blood thinners in the interim.²⁴ This is one of the most individualized parts of pre-bronchoscopy planning, and your team should walk you through the specifics.

Robotic-Assisted Bronchoscopy

Robotic-assisted bronchoscopy (RAB) is one of the newer developments in the field, using a steerable catheter controlled by a physician at a console to reach small nodules deep in the lung. A systematic review and meta-analysis found that RAB achieved a diagnostic yield of about 70% to 89% depending on how strictly success was defined, with a safety profile that compared favorably to older navigational techniques.²⁵ The pneumothorax rate with RAB was about 2.3%, with about half of those patients needing a chest tube, and significant hemorrhage occurred in only about 0.5%.²⁶

When robotic bronchoscopy was compared directly with CT-guided needle biopsy through the chest wall (the main alternative for hard-to-reach nodules), the robotic approach had dramatically lower pneumothorax and hospital admission rates.²⁷ Shape-sensing robotic systems showed no procedure-related complications in one comparative study, while virtual bronchoscopic navigation produced two cases of pneumothorax.²⁸ These platforms are still relatively new and not available everywhere, but the early safety data is encouraging for patients who need biopsies of peripheral lung nodules.

Pre-Procedure Anxiety Versus Actual Experience

It is completely normal to feel anxious before a bronchoscopy. In a study measuring pre-procedure anxiety on a 10-point scale, the median score was a 5, squarely in the moderate range. Women tended to report higher anxiety than men. But the finding that stands out is what happened afterward: 90% of patients said they would consent to the procedure again without hesitation. The strongest predictor of dissatisfaction was not any complication; it was how anxious the patient felt beforehand. Anxiety and physical discomfort during the scope both correlated with lower satisfaction, while the actual medical outcome played a smaller role in how people felt about the experience.²⁹

This has a practical implication: if your anxiety about bronchoscopy is high, raising it with your doctor may improve both your comfort and your satisfaction. Adequate sedation, clear expectations, and even simple conversation about what you will feel during the procedure can make a real difference. The procedure’s safety track record is strong; your subjective experience of it often comes down to preparation and communication more than medical risk.

1
PubMed Central. Complications of bronchoscopy: A concise synopsis
2
PubMed Central. Safety of flexible bronchoscopy in elderly patients
3
PubMed. Survey of flexible fibreoptic bronchoscopy in the United Kingdom
4
PubMed Central. Iatrogenic bleeding during flexible bronchoscopy: risk factors, prophylactic measures and management
5
PubMed Central. The hemorrhage risk of patients undergoing bronchoscopic examinations or treatments
6
PubMed Central. Risk of iatrogenic pneumothorax based on location of transbronchial biopsy: a retrospective cohort study
7
PubMed Central. Transbronchial biopsy from the upper pulmonary lobes is associated with increased risk of pneumothorax – a retrospective study
8
PubMed Central. Fever after bronchoscopy: serum procalcitonin enables early diagnosis of post-interventional bacterial infection
9
European Respiratory Review. Comparative analysis of guidelines and recommendations for sedation during flexible bronchoscopy: a narrative review
10
PubMed Central. Risk Factors for Predicting Hypoxia in Adult Patients Undergoing Bronchoscopy under Sedation
11
PubMed Central. Safety and Efficacy of the Moderate Sedation During Flexible Bronchoscopic Procedure A Systematic Review and Meta-Analysis of Randomized Controlled Trials
12
PubMed Central. Flexible versus Rigid Bronchoscopy for Tracheobronchial Foreign Body Removal in Children: A Comparative Systematic Review and Meta-Analysis
13
PubMed. Complications of bronchoscopy: comparison of rigid bronchoscopy under general anesthesia and flexible fiberoptic bronchoscopy under topical anesthesia
14
Breathe. Interventional bronchoscopy in lung cancer treatment
15
PubMed Central. Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy
16
PubMed Central. Complications of linear endobronchial ultrasound guided biopsies: narrative review
17
PubMed. Diagnostic Yield and Complications of EBUS-TBNA Performed Under Bronchoscopist-directed Conscious Sedation
18
PubMed. Bronchoscopy Safety in Patients With Chronic Obstructive Lung Disease
19
PubMed. Complications and safety analysis of diagnostic bronchoscopy in COPD: a systematic review and meta-analysis
20
PubMed Central. Other Indications, Efficacy, and Complications of Pediatric Bronchoscopy: A Retrospective Study at a Tertiary Center
21
PubMed. Complications and risk factors in pediatric bronchoscopy in a tertiary pediatric respiratory center
22
PubMed. The risks of postoperative complications and prolonged hospital stay in children receiving bronchoscopy
23
PubMed. Management of antithrombotic agents in patients undergoing flexible bronchoscopy
24
PubMed Central. Management of oral antiplatelet agents and anticoagulation therapy before bronchoscopy
25
PubMed Central. Diagnostic performance and safety for robotic-assisted bronchoscopy in pulmonary nodules: a systematic review and meta-analysis
26
Annals of the American Thoracic Society. Diagnostic Performance and Safety Profile of Robotic-assisted Bronchoscopy: A Systematic Review and Meta-Analysis
27
European Respiratory Journal. Robot-Assisted Bronchoscopy vs CT-Guided Biopsy: Weighing Safety in Pulmonary Nodule Evaluation
28
Scientific Reports. Shape sensing robotic assisted bronchoscopy versus virtual bronchoscopic navigation in the diagnosis of peripheral pulmonary nodules
29
PubMed Central. Evaluation of patients’ satisfaction with bronchoscopy procedure