What is a Bronchoscopy?
Patients that have received a lung transplant know too well what a bronchoscopy is. For the ones on the waiting list who never had one; don’t worry you will get to know. A bronchoscopy is usually done by a pulmonologist (lung doctor) and consist a small camera at the end of a long probe narrow enough to fit through the airway. It can be inserted through the nose or mouth and also through the breathing tube is the patient is still on the breathing machine (ventilator). That camera is inserted all the way down in both lungs while the patient is lightly sedated. The patient usually receives what some hospitals called conscious sedation. That basically means that you are awake enough to breath and gag but sleepy enough to think what’s happening is only a bad dream.
Indications after Lung Transplant
There are mainly 2 reasons doctors will do a bronchoscopy after lung transplant. The first reason is for diagnostic purposes when the physician may or may not suspect something wrong but needs to find out. It is called a surveillance bronchoscopy. A bronchoscopy is done at scheduled intervals after the transplant to see if the body is rejecting the new lungs. A rejection is a sign that the body is not accepting the organ and is trying to get rid of it just like it was a bacteria. It needs immediate medical treatment once diagnosed. Biopsies will be taken from several different locations in the lungs to look for possible rejection. A biopsy consists of removing a tiny bit of lung tissue and to send it to the lab under the microscope. Usually the doctor will repeat that 6 to 8 times at each bronchoscopy depending on how the patient tolerate it and how much it bleeds. It takes about 24 hours to know if the lung biopsy showed a rejection or not.
Another diagnostic reason to do a bronch is when a patient shows some signs of lung infection and a culture needs to be performed. By performing a culture, the pulmonologist will be able to identify the bug (bacteria, virus or fungi) that has invaded the new lung and treat it accordingly. Unfortunately, a lot of lung transplant patients are infected with “superbugs” that require powerful antibiotics because they have adapted and become resistant to the weaker ones like Cipro or Levaquin.
The other purpose of a bronchoscopy has therapeutic intentions. In other words it means to treat a condition found in the lungs where the patient is experiencing lung transplant complications. The main one that we see is accumulation of thick mucus that will sometimes occlude part of the lung. The doctor will use the scope and go in and wash it out real good. The real term used for the occlusion is a mucus plug. Usually a patient feels 100% better once that issue is fixed.
A more rare complication after lung transplant is called bronchial stenosis. Stenosis means narrowing. So bronchial stenosis means that the bronchus has become narrow and it is more difficult for the air to go through. That usually happens at the site where the surgeon reattached together the new lung with the patient’s own bronchus. The scar tissue that forms can make the air passage more narrow. That condition is diagnosed during a bronchoscopy and can be treated by 2 ways that are pretty similar to what a cardiologist will do to clear blockages in a heart. The first step is to use a balloon that is inflated at the narrow spot with the goal to open it up. If it opens up and stays like that, it is good. If it closes back up, then a stent may be deployed to keep it open. Just like in your heart. The difference is it happens in the lung, not in the bloodstream.
These were the main reasons bronchoscopies are done on lung transplant patients. The number one thing that is always suspected early on after transplant regardless if the patient has any symptoms is rejection. This is why bronchoscopies are performed so routinely to catch and treat them early.