Departments: Interventional Pulmonology in Other Journals
Comparison of Direct Vision and Video Imaging During Bronchoscopy for Pediatric Airway Foreign Bodies
Ear Nose Throat J. 2003;82: 129–133. Yang CC, Lee KS. Head and Neck Surgery, Mackay Memorial Hospital, Taipei.
This retrospective study describes the comparison and contrasts between direct vision rigid bronchoscopy versus video-rigid bronchoscopy in a group of 114 children subjected to bronchoscopy for suspected airway foreign bodies. The patients included 76 boys and 38 girls. The mean age was 26 months (range, 7 mo to 10 y), and 95 (83%) of the children were younger than 37 months of age. During a 12-year period, the authors performed bronchoscopy under direct vision in 48 (42%) children and videobronchoscopy with video tape recording in 66 children (58%). All procedures were performed under general anesthesia. The most common presenting symptoms were choking, dyspnea, and persistent cough. A total of 112 airway foreign bodies were extracted in 104 patients. The most common foreign body was the peanut, found in 62% of patients. Analysis of the data showed that the positive rate on first-look direct vision was 94% and the positive rate on first-look video imaging was 89%. Nevertheless, only one of the video-imaging patients underwent a second procedure, and no foreign body was found. On the other hand, 3 foreign-body-negative patients in the direct-vision group underwent a second procedure and a foreign body was found in all 3. The difference in the positive rates after the second procedure was statistically significant (P < 0.05). According to the authors, this might be attributable to the higher success rate with video imaging following the first procedure, which significantly reduced the need for a second look and the possibility of overlooked or residual foreign bodies. The condition of the mucosa postprocedurally was described in every case after video imaging but after only 42% of the direct-vision cases, a statistically significant difference (P < 0.001). The authors conclude that video imaging provides the physician with a clear, magnified view of the area under examination, and it allows for later review of the videotape when necessary and reduces the risk of residual foreign body in the airway. It is easy to understand and concur that when one videotapes the entire bronchoscopy procedure and reviews the tape at the conclusion of the procedure; one has the luxury of detecting certain endobronchial abnormalities not observed during the actual procedure. It is as though the procedure is performed a second time on the same patient for the same indication. Another advantage of the video-taping and viewing the findings later is that other experts in bronchoscopy can also view the findings and provide input into “newer” findings that were missed during the first look. Another advantage is that taped images can be used effectively for teaching purposes, lecture presentations, and for publication in scientific literature. These advantages are absent if direct-look bronchoscopy is performed without recording of the procedure for later review. Having stated the advantages of video-bronchoscopy, it is also important to recognize that experienced bronchoscopists rarely miss clinically significant abnormalities. Furthermore, videotaping facilities are not always available or practical. The major problem is the lack of time to review every videotape after concluding the bronchoscopy procedure. Therefore, it is better to diligently examine the airways the first time so that second-looks and review of taped images will be unnecessary.