Practice and complications of flexible bronchoscopy with biopsy procedures

Rationale: Bronchoscopy is a frequently performed procedure, but most reports on how the procedure is performed and associated side effects are derived from retrospective chart reviews and single-center studies. The present study describes its practice and side effects in a multicenter cohort. Methods: During a study examining the efficacy of an autofluorescence system, detailed reports were obtained about how bronchoscopy was performed. The procedure was left at the discretion of the investigators with the exception of the autofluorescence examination having to precede all other interventions. The trial was performed in 6 medical centers in the United States. Eligible subjects were patients at high risk for lung cancer or with symptoms/findings suggestive of the disease. All patients underwent white light and blue light endoscopy in the same setting. Results: Three hundred patients were enrolled. There were 180 males and 120 females with a median age of 66.4 years (range, 38-88 years). Conscious sedation was given in 90% of patients and the mean procedure time for the examination was 32 minutes (range, 5-134 minutes). A nasal approach was chosen in 54%. All patients underwent at least 2 endobronchial biopsies per study protocol. Adverse events were noted in 35% of cases, most of them mild (sore throat 10%, hemoptysis 8%, bleeding 4%, cough 3%). Severe adverse events occurred in 10% and required hospitalizations for cardiac arrhythmias, chronic obstructive pulmonary disease exacerbations, and hypoxia. Four patients (2%) expired secondary to hemoptysis, hypoxia, vasovagal reaction, and ventricular fibrillation, respectively. Conclusions: In a well-controlled cohort of patients undergoing routine bronchoscopic biopsy procedures for suspicion of lung cancer, side effects are more common than previously thought, but generally mild. Bleeding and hemoptysis are common. The mortality rate at 2% is higher than previously reported.