Interventional bronchoscopy in pediatric pulmonary tuberculosis

ABSTRACT

Introduction

Lymphobronchial tuberculosis (TB) is common in children with primary TB and enlarged lymph nodes can cause airway compression of the large airways. If not treated correctly, airway compression can result in persistent and permanent parenchymal pathology, as well as irreversible lung destruction. Bronchoscopy was originally used to collect diagnostic samples; however, its role has evolved, and it is now used as an interventional tool in the diagnosis and management of complicated airway disease. Endoscopic treatment guidelines for children with TB are scarce.

Areas covered

The role of interventional bronchoscopy in the diagnosis and management of complicated pulmonary TB will be discussed. This review will provide practical insights into how and when to perform interventional procedures in children with complicated TB for both diagnostic and therapeutic purposes. This discussion incorporates current scientific evidence and refers to adult literature, as some of the interventions have only been done in adults but may have a role in children. Limitations and future perspectives will be examined.

Expert opinion

Pediatric pulmonary TB lends itself to endoscopic interventions as it is a disease with a good outcome if treated correctly. However, interventions must be limited to safeguard the parenchyma and prevent permanent damage.

KEYWORDS:

• Flexible bronchoscopy
• interventional bronchoscopy
• pulmonary tuberculosis
• rigid bronchoscopy
• Xpert MTB/RIF

Article highlights

• EBUS may be used to biopsy mediastinal lymph nodes for confirmation as well as to determine drug sensitivities in children where conventional samples have failed.

• By combining imaging and bronchoscopy, biopsy sites can be identified, improving the chances of a successful biopsy or intervention.

• Interventional endoscopic procedures are required in the management of complicated TB to prevent parenchymal damage; most of these procedures have limited complications and may avoid the need for open thoracotomy.

• Cryotherapy may have a role in both the diagnosis and management of TB.

• There is a lack of training opportunities in many of these interventional procedures, and pediatric pulmonologists may need to collaborate with their adult counterparts.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A peer reviewer on this manuscript received an honorarium from Expert Review of Respiratory Medicine for their review work. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.