Pediatric bronchoscopy: recent advances and clinical challenges

ABSTRACT

Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and interventional options.

Areas covered: We provide a review of recent advances and clinical challenges in pediatric bronchoscopy. This includes single-use bronchoscopes, endobronchial ultrasound, and cryoprobe. Bronchoscopy in persistent preschool wheezing and asthma is included. The indications for interventional bronchoscopy have amplified and included balloon dilatation, endoscopic intubation, the use of airway stents, whole lung lavage, closing of fistulas and air leak, as well as an update on removal of foreign bodies. Others include the use of laser and microdebrider in airway surgery. Experience with bronchoscope during the COVID-19 pandemic has been included in this review. PubMed was searched for articles on pediatric bronchoscopy, including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years.

Expert opinion: As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed. There is a scarcity of published evidence in this field. Courses for pediatric interventional bronchoscopy need to be developed. The COVID-19 experience resulted in safer bronchoscopy practice for all involved.

KEYWORDS:

• Pediatric bronchoscopy
• rigid bronchoscopy
• interventional bronchoscopy
• endobronchial ultrasound
• airway stents
• covid-19

Article highlights

• The first bronchoscope was developed by Gustav Killian for the purpose of removing a foreign body.

• Chevalier Jackson developed the procedure in pediatric patients and also designed many tools in the early 20th century. The first fibreoptic bronchoscope was developed by Shigeto Ikeda in 1967 but paediatric equipment was only available from the 1980s. Robert E. Wood was responsible for the introduction of a small enough scope to allow the inspection of the airways of small infants and children.

• The primary aim of the physician is to do no harm. Many new indications for interventional bronchoscopy have appeared. Very few of them have been scientifically evaluated. Working in teams will create safety, improve outcomes, and promote research.

• The major indication for paediatric bronchoscopy remains diagnostic. Bronchoscopy is now more often indicated in children with preschool wheezing as many of these children may have functionally or structurally abnormal airways.

• Advances in bronchoscopy equipment allow for many different endoscopic procedures to be performed, reducing the need for open surgery.

• Improved technology aids in biopsy guidance of mediastinal lymph nodes with the use of endobronchial ultrasound (EBUS).

• Placement of airway stents in children is technically feasible for experienced bronchoscopists, and procedure-related morbidity and mortality are low. Currently insufficient experience exists to draw conclusions regarding the utility of biodegradable stents, and their safety and efficacy need to be verified in animal studies and clinical trials.

• The COVID-19 pandemic has added many new challenges. Bronchoscopy is associated with increased risk of patient‐to‐health care worker transmission, owing to aerosolized viral particles, which may be inhaled or result in environmental contamination of surfaces.

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

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.