Bronchoscopy (NBI and AFI)

In diagnostic bronchoscopy, a flexible bronchoscope is used to visually inspect the trachea and bronchi.

Narrow Band Imaging (NBI) and Autofluorescence Imaging (AFI) are two modalities that are deservedly gaining greater interest in the medical community. To a significant degree, this is due to their ability to provide more information that can lead to faster and more accurate diagnosis of a number of conditions, particularly relating to tissue thickening.

NBI provides great potential for defining the nature of a bronchial lesion, allowing a closer, more accurate look at the angiogenic process. NBI is a promising technology as it combines good sensitivity with improved specificity. It allows superior discrimination between low- and high-risk lesions (such as CIS and severe dysplasia). NBI is available with standard videoscopes on recent Olympus video endoscopy platforms.

Sampling

For general diagnostic purposes or if an abnormality is discovered, sampling using Bronchoscopic Alveolar Lavage (BAL), brush, forceps, or needle might be needed.

• Olympus offers balloon catheters in two different sizes and a washing pipe for peripheral BAL
• Olympus offers a versatile line up of brushes to meet the needs of specific clinical requirements. The metal tip of the brushes enables perfect visibility under fluoroscopy and leads to atraumatic brushing.
• Bronchoscopists have identified a number of advantages offered by Olympus biopsy forceps. The sharpened cups ensure superior cutting performance, which can lead to fewer artefacts and less bleeding. The high-quality stainless steel allows smooth cup operation in any situation. There are no sharp edges and the swinging-type head ensures full compliance to even angulated working channels. Some target sites are difficult to approach, but the reusable Olympus SwingJaw biopsy forceps and EndoJaw single-use swinging cup forceps allow tangential targeting of the lesion.
• Olympus offers an extended range of needles for cytology and histology to meet a variety of clinical requirements. Olympus TBNA needles offer excellent puncture performance and their sophisticated design reduces damage inside the scope channel while ensuring the smoothest passage through the channel. There are standard, side-hole, and trocar type needles available. The unique side hole allows the drawing of more specimens from tissue in contact with the side of the needle.

Foreign Body Removal

The removal of a foreign body using bronchoscopy can be challenging due to its size and consistency, as well as due to the limited access to its location. Objects may be removed with the help of a flexible bronchoscope and the appropriate grasping instruments.

A variety of instruments, such as grasping forceps or retrieval baskets, can be used to remove foreign bodies, depending on the type of object involved. Olympus offers a versatile product line up of grasping forceps, baskets, and loops to extract foreign bodies:

• Superb grasping power for reliable and safe extraction
• Various designs to grasp different types of foreign bodies
• Single-use and reusable devices available
• Also for 1.2 mm biopsy channels for peripheral and pediatric foreign body removal

Grasping devices – the appropriate device for every situation

• Forceps with rubber tip for sharp or flat objects like needles and pins. Ideal for slippery foreign bodies.
• Forceps with V-shape for thin and flat objects. Rat tooth allows a firm grip.
• Forceps with rat tooth for flat objects such as coins. Rat tooth allows a firm grip.
• Forceps with alligator jaws for holding of object to be removed. Alligator jaws prevent slipping of foreign body.
• Removal baskets for smooth and round objects or large foreign bodies.

Energy

Bronchoscopic electrosurgery can be used for a number of bronchoscopy applications, for example, tumour ablation and debulking, cauterisation of lesions, haemostasis, and bronchial biopsies.

Immediate medical attention is often required in the treatment of tumours obstructing the trachea or the bronchus. In the past, the tumours were resected through thoracotomy or removed by forceps using rigid bronchoscopes. However, bronchoscopic electrosurgery is a cost-effective alternative for tumour ablation and debulking.

Post-intubation tracheal stenosis can be caused by multiple factors and is a complication of prolonged endotracheal intubation. If the stenosis is a web-like type, reopening with electrosurgical knife is possible.

Haemostasis can be achieved effectively using electrocautery. Bleeding in the bronchi can occur while taking a biopsy or debulking a tumour. Smaller bleeds are generally not problematic, but they can become life-threatening if the bleeding cannot be stopped.

Bronchial biopsies can be performed using hot biopsy forceps, which are equipped with large cups that allow fast, efficient collection of tissue using high-frequency cauterisation to prevent bleeding.

Cut, Coagulate, Resect and Retrieve
Olympus has designed versatile electrosurgical devices to meet many requirements for high-frequency bronchial electrocautery.

• Designed exclusively for transbronchial applications
• Simple and for immediate use
• Green distal marking to ensure safe product handling
• Less expensive than laser

Paediatric

Flexible bronchoscopy is widely used in the diagnosis of respiratory pathologies in children of all ages. Biopsies, bronchoscopic cytology, and foreign body removal present common challenges that can be met with the selection of the appropriate techniques and instruments.

Olympus offers a full line up of mini-instruments for paediatric bronchoscopy which are compatible with 1.2 mm channel bronchoscopes for diagnostic and therapeutic procedures in the peripheral lung and small bronchi of children.

This range covers grasping forceps and baskets for foreign bodies of different shapes and surfaces and forceps and cytology brushes for diagnosis even from the small bronchi.

Biopsy Forceps

• Rat tooth to aid anchorage
• Elongated cups for deeper biopsies

Cytology Brush

• For optimised cytological yield
• Sheathed and unsheathed types

Grasping Baskets

• For retrieval of smooth, rounded objects

Extraction Bags

• For retrieval of sharp and larger round objects

Grasping Forceps

• For retrieval of irregular objects
• Nails bite into soft objects for improved grip

Foreign Body Removal Snare

• For retrieval of long, thin objects