Flexible bronchoscopy

There have been dramatic advances in the field of bronchoscopy over recent years, with a multitude of standard and specialized techniques being used by bronchoscopists in the diagnosis and management of respiratory disease, particularly in lung cancer. Standard techniques universally used in respiratory departments include endobronchial and transbronchial biopsy, bronchial washing and brushing, and bronchoalveolar lavage. Specialized techniques used in the diagnosis and staging of lung cancer include endobronchial ultrasound-guided transbronchial needle aspiration and autofluorescence bronchoscopy. In the treatment of endobronchial tumours, techniques such as photodynamic therapy, brachytherapy, electrocautery, cryotherapy and stenting are available. These are used for the palliation of more advanced tumours causing airway obstruction and, in some occasions, for treatment of early-stage endobronchial disease. There have also been exciting advances in the bronchoscopic management of non-malignant respiratory disease, such as endobronchial valves for lung volume reduction therapy in severe emphysema. This article will provide an overview of these techniques.