Thin bronchoscope for evaluating stenotic airways during stenting procedures

Background: Flexible bronchoscopy can play an important role in the evaluation of an airway lumen during therapeutic bronchoscopic procedures. Despite its potential usefulness, however, evaluation with a standard-sized bronchoscope, which cannot pass completely through a severely stenosed airway, is often unsatisfactory. Objectives: This study aimed to evaluate the usefulness of prototype thin bronchoscopes for assessing stenotic airways during stenting procedures. Methods: Forty-six patients with central airway stenosis requiring stent implantation were enrolled in this prospective study. After inserting a rigid bronchoscope under general anesthesia, a flexible bronchoscopic evaluation using a 5.9- or 6.0-mm standard bronchoscope was performed, followed by evaluation using a prototype 3.4- or 3.5-mm thin bronchoscope for airways beyond the site of stenosis, which could not be visualized by the standard bronchoscope. Results: A standard bronchoscope could not pass through the stenotic airway in 15 of 46 patients (33%). On univariate analysis, the grade of stenosis (p < 0.001), the presence or absence of atelectasis (p = 0.04) and the presence or absence of viscous secretions (p = 0.02) were related to the rate of successful passage by a standard bronchoscope. On multivariate analysis, only the grade of stenosis remained independently associated with the success rate. In 12 of the 15 patients (80%), the airway lumen beyond the stenotic lesion, which could not be reached by a standard bronchoscope, was successfully visualized and evaluated with a thin bronchoscope. No significant complications were associated with the procedures. Conclusion: The thin bronchoscope can be a useful tool for evaluating a severely stenosed airway during the stenting procedure.