Flexible Bronchoscopy in Children: The Marmara University Division of Pediatric Pulmonology Experience

Yıl 2022, Cilt: 22 Sayı: 2, 99 - 104, 09.09.2022

Almala Pınar Ergenekon , Ecenur Şahin Cansu Yılmaz Yeğit Mürüvvet Yanaz Aynur Gulieva Mine Kalyoncu , Merve Selçuk Ela Erdem Eralp , Yasemin Gökdemir Bülent Karadağ

https://doi.org/10.26650/jchild.2022.1078223

Öz

Objective: The use of flexible bronchoscopy for diagnosis and/or treatment in pediatric patients has increased considerably in recent years with new indication areas. The aim of the current study is to present our experience with 732 flexible bronchoscopy procedures performed over 5 years in our Pediatric Pulmonology Clinic. Materials and Method: The study involves children under the age of 18 years who’ve undergone flexible bronchoscopy. Demographic characteristics, flexible bronchoscopy indications and findings, complications, and bronchoalveolar lavage results have been recorded. Results: Patients’ median age is 5 years (range from 2-10 years). The most common indication of FB is recurrent lower respiratory tract infection (29.6%), followed by chronic cough (16.4%). Of the patients 49 (6.7%) had an immunodeficiency and 42 (5.7%) had a malignancy. The bronchoscopic evaluations revealed normal airway anatomies in 250 (34.2%) patients. At least one pathological finding was detected in 482 (65.8%) patients. The most common findings were increased airway secretions in 268 (36.6%) patients and bronchomalacia in 66 (9%) patients. Microbiological growth presented for at least one microorganism in 111 (20.8%) patients. Haemophilus infleunzae was the most frequently identified bacteria. No major complications were observed. Conclusion: Flexible bronchoscopy is very valuable for patients with recurrent lower respiratory tract infections in terms of bronchoalveolar lavage culture results and appropriate antibiotic therapy. Flexible bronchoscopy is essential for detecting laryngomalacia or secondary airway lesions in patients with stridor and is an important tool for definitively diagnosing bronchomalacia in patients with persistent wheezing and chronic cough.

Çocuklarda Fleksibl Bronkoskopi- Marmara Çocuk Göğüs Hastalıkları Deneyimi

Öz

Amaç: Fleksibl bronkoskopinin pediatrik hastalarda tanı ve/veya tedavi amaçlı kullanımı yeni endikasyon alanlarıyla son yıllarda oldukça artış göstermiştir. Bu çalışmada amacımız Çocuk Göğüs Hastalıkları kliniğimizde 5 yıllık sürede gerçekleştirdiğimiz 732 fleksibl bronkoskopi işlemi ile ilgili deneyimimizi sunmaktır. Gereç ve Yöntem: 2016-2021 yılları arasında fleksibl bronkoskopi işlemi uygulanan 18 yaş altı çocuklar çalışmaya dahil edildi. Hastaların tıbbi kayıtları incelendi ve demografik özellikleri, bronkoskopi endikasyonları, bronkoskopi bulguları, komplikasyonlar ve bronkoalveoler lavaj sonuçları kayıt edildi. Bulgular: Hastaların ortanca yaşı 5 yıl idi. Fleksibl bronkoskopinin en sık endikasyonu tekrarlayan alt solunum yolu enfeksiyonu (%29,6), ikinci en sık neden kronik öksürük (%16,4) idi. Fleksibl bronkoskopi yapılan hastaların 49’unda (%6,7) immun yetmezlik, 42’sinde (%5,7) malignite mevcuttu. Bronkoskopik değerlendirmeler 250 (%34,2) hastada normal hava yolu anatomisi ortaya koyarken, 482 (%65,8) hastada en az bir patolojik bulgu saptadı. En sık görülen bulgular 268 (%36,6) hastada havayolu sekresyonları artışı ile 66 (%9) hastada bronkomalazi idi. Hastaların 111’inde (%20,8) mikrobiyolojik üreme mevcuttu. Haemophilus influenzae en sık bulunan bakteri idi. Hiçbir hastada majör komplikasyon gözlenmedi. Sonuç: Fleksibl bronkoskopi, tekrarlayan alt solunum yolu enfeksiyonu olan hastalarda bronkoalveoler lavaj kültür sonuçları ile uygun antibiyotik tedavisinin verilebilmesi açısından çok önemlidir. Stridoru olan hastalarda laringomalazi veya ikincil hava yolu lezyonlarının; persistan hışıltı ve kronik öksürüğü olan hastalarda bronkomalazinin kesin tanısı için önemli bir araçtır.

Anahtar Kelimeler

Çocuk, fleksibl bronkoskopi, bronkoalveoler lavaj

Kaynakça

• 1. Efrati O, Sadeh-Gornik U, Modan-Moses D, Barak A, Szeinberg A, Vardi A, et al. Flexible bronchoscopy and bronchoalveolar lavage in pediatric patients with lung disease. Pediatr Crit Care Med 2009;10(1):80-4. google scholar
• 2. Piccione J, Hysinger EB, Vicencio AG. Pediatric advanced diagnostic and interventional bronchoscopy. Semin Pediatr Surg 2021;30(3):151065. google scholar
• 3. Schramm D, Yu Y, Wiemers A, Vossen C, Snijders D, Krivec U, et al. Pediatric flexible and rigid bronchoscopy in European centers-Availability and current practice. Pediatr Pulmonol 2017;52(11):1502-8. google scholar
• 4. Nussbaum E. Pediatric fiberoptic bronchoscopy: Clinical experience with 2,836 bronchoscopies. Pediatr Crit Care Med 2002;3(2):171-6. google scholar
• 5. Shah MB, Bent JP, Vicencio AG, Veler H, Arens R, Parikh SR. Flexible bronchoscopy and interdisciplinary collaboration in pediatric large airway disease. Int J Pediatr Otorhinolaryngol 2008;72(12):1771-6. google scholar
• 6. Midulla F, de Blic J, Barbato A, Bush A, Eber E, Kotecha S, et al. ERS Task Force. Flexible endoscopy of paediatric airways. Eur Respir J 2003;22(4):698-708. google scholar
• 7. Faro A, Wood RE, Schechter MS, Leong AB, Wittkugel E, Abode K, et al. American Thoracic Society Ad Hoc Committee on Flexible Airway Endoscopy in Children. Official American Thoracic Society technical standards: flexible airway endoscopy in children. Am J Respir Crit Care Med 2015;191(9):1066-80. google scholar
• 8. KabirAL, MajumderJU, MridhaAA, RahmanM, AminMR. Pediatric flexible fiberoptic bronchoscopy. Bangladesh J Child Heal 2010; 29:99e103. google scholar
• 9. Lee SL, Cheung YF, Leung MP, Ng YK, Tsoi NS. Airway obstruction in children with congenital heart disease: assessment by flexible bronchoscopy. Pediatr Pulmonol 2002;34(4):304-11. google scholar
• 10. Atag E, Unal F, Yazan H, Girit S, Uyan ZS, Ergenekon AP, et al. Pediatric flexible bronchoscopy in the intensive care unit: A multicenter study. Pediatr Pulmonol 2021;56(9):2925-31. google scholar
• 11. de Benedictis FM, Bush A. Recurrent lower respiratory tract infections in children. BMJ 2018;362:k2698. google scholar
• 12. Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K, et al. Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report. Chest 2017;151(4):884-90 google scholar
• 13. 2019 GINA Main Report [Internet]. Global Initiative for Asthma-GINA. https://ginasthma.org/gina-reports/. google scholar
• 14. Carlens J, Fuge J, Price T, DeLuca DS, Price M, Hansen G, et al. Complications and risk factors in pediatric bronchoscopy in a tertiary pediatric respiratory center. Pediatr Pulmonol. 2018;53(5):619-627. google scholar
• 15. Marchant JM, Masters IB, Taylor SM, Cox NC, Seymour GJ, Chang AB. Evaluation and outcome of young children with chronic cough. Chest 2006;129(5):1132-41. google scholar
• 16. De Schutter I, De Wachter E, Crokaert F, Verhaegen J, Soetens O, Pierard D, et al. Microbiology of bronchoalveolar lavage fluid in children with acute nonresponding or recurrent community-acquired pneumonia: identification of nontypeable Haemophilus influenzae as a major pathogen. Clin Infect Dis 2011;52(12):1437-44. google scholar
• 17. de Blic J, Midulla F, Barbato A, Clement A, Dab I, Eber E, et al. Bronchoalveolar lavage in children. ERS Task Force on bronchoalveolar lavage in children. European Respiratory Society. Eur Respir J 2000;15(1):217-31. google scholar
• 18. Ferraro VA, Baraldi E, Stabinger D, Zamunaro A, Zanconato S, Carraro S. Pediatric flexible bronchoscopy: A single-center report. Pediatr Pulmonol 2021;56(8):2634-41. google scholar
• 19. Gokdemir Y, Cakir E, Kut A, Erdem E, Karadag B, Ersu R, et al. Bronchoscopic evaluation of unexplained recurrent and persistent pneumonia in children. J Paediatr Child Health 2013;49(3):E204-7. google scholar
• 20. Kantar A. Phenotypic presentation of chronic cough in children. J Thorac Dis 2017;9(4):907-13. google scholar
• 21. Morice AH, Millqvist E, Bieksiene K, Birring SS, Dicpinigaitis P, Domingo Ribas C, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 2020;55(1):1901136. google scholar
• 22. Kantar A, Chang AB, Shields MD, Marchant JM, Grimwood K, Grigg J, et al. ERS statement on protracted bacterial bronchitis in children. Eur Respir J 2017;24;50(2):1602139. google scholar
• 23. Lau GTY, Laird P, Stevenson PG, Schultz A. Frequency of protracted bacterial bronchitis and management pre-respiratory referral. J Paediatr Child Health 2022;58(1):97-103. google scholar
• 24. Verhulst S, Boel L, Van Hoorenbeeck K. Protracted bacterial bronchitis: bronchial aspirate versus bronchoalveolar lavage findings: a single-centre retrospective study. BMJ Paediatr Open 2019;20;3(1):e000507. google scholar
• 25. Ren CL, Esther CR Jr, Debley JS, Sockrider M, Yilmaz O, Amin N, et al. ATS Ad Hoc Committee on Infants with Recurrent or Persistent Wheezing. Official American Thoracic Society Clinical Practice Guidelines: Diagnostic Evaluation of Infants with Recurrent or Persistent Wheezing. Am J Respir Crit Care Med 2016; 1;194(3):356-73. google scholar
• 26. Hayden L, Boyer D, Hysinger EB, Moore PE, Faro A, Wilson KC, Thomson CC. Flexible Airway Endoscopy in Children. Ann Am Thorac Soc 2015;12(12):1873-5. google scholar
• 27. Schellhase DE, Fawcett DD, Schutze GE, Lensing SY, Tryka AF. Clinical utility of flexible bronchoscopy and bronchoalveolar lavage in young children with recurrent wheezing. J Pediatr 1998;132:312-8. google scholar
• 28. Saito J, Harris WT, Gelfond J, Noah TL, Leigh MW, Johnson R, et al. Physiologic, bronchoscopic, and bronchoalveolar lavage fluid findings in young children with recurrent wheeze and cough. Pediatr Pulmonol 2006;41(8):709-19. google scholar
• 29. Cakir E, Ersu RH, Uyan ZS, Oktem S, Karadag B, Yapar O, et al. Flexible bronchoscopy as a valuable tool in the evaluation of persistent wheezing in children. Int J Pediatr Otorhinolaryngol 2009;73(12):1666-8. google scholar
• 30. De Baets F, De Schutter I, Aarts C, Haerynck F, Van Daele S, De Wachter E, et al. Malacia, inflammation and bronchoalveolar lavage culture in children with persistent respiratory symptoms. Eur Respir J 2012;39(2):392-5. google scholar
• 31. Aslan AT, Kiper N, Dogru D, Karagoz AH, Ozcelik U, Yalcin E. Diagnostic value of flexible bronchoscopy in children with persistent and recurrent wheezing. Allergy and Asthma Proc 2005;26:483-6. google scholar
• 32. Saglani S, Nicholson AG, Scallan M, Balfour-Lynn I, Rosenthal M, Payne DN, et al. Investigation of young children with severe recurrent wheeze: any clinical benefit? Eur Respir J 2006;27(1):29-35. google scholar
• 33. Sovtic A, Grba T, Grahovac D, Minic P. Flexible Bronchoscopy in Evaluation of Persistent Wheezing in Children-Experiences from National Pediatric Center. Medicina (Kaunas) 2020;2;56(7):329. google scholar
• 34. Norzila MZ, Norrashidah AW, Rusanida A, Sushila S, Azizi BH. Local experience in paediatric flexible bronchoscopy. Med J Malaysia 2003;58(3):350-5. google scholar
• 35. Erdem E, Gokdemir Y, Unal F, Ersu R, Karadag B, Karakoc F. Flexible bronchoscopy as a valuable tool in the evaluation of infants with stridor. Eur Arch Otorhinolaryngol 2013;270(1):21-5. google scholar
• 36. Vijayasekaran D, Gowrishankar NC, Kalpana S, Vivekanandan VE, Balakrishnan MS, Suresh S. Lower airway anomalies in infants with laryngomalacia. Indian J Pediatr 2010;77(4):403-6. google scholar
• 37. Masters IB, Chang AB, Patterson L, Wainwright C, Buntain H, Dean BW, et al. Series of laryngomalacia, tracheomalacia, and bronchomalacia disorders and their associations with other conditions in children. Pediatr Pulmonol 2002;34(3):189-95. google scholar
• 38. Kut A, Cakir E, Gokdemir Y, Midyat L, Ersu R, Erdem E, et al. Intrinsic endobronchial obstructions in children from Turkey: evaluation of 2,555 flexible bronchoscopic procedures. Respiration 2013;85(1):43-8. google scholar