[Complication of flexible fiberoptic bronchoscopy. Literature review]

Fiberoptic bronchoscopy is the gold standard to study and eventually treat tracheo-bronchial pathology. Performance of fiberoptic bronchoscopy enhances diagnostic precision and has not well documentated risks for the patients. This review examines the international literature of the last 30 yrs about the indication, complications and their prevention during bronchoscopy.

We reviewed by Internet 50 scientific articles, 23 of those were reporting or citing other experiences. We included as metasearch criteria "flexible", "fiberoptic", "bronchoscopy" and "complications" from 1974 to 2006, and as exclusions terms "pediatry", "pregnancy" and "urgency/emergency". Thus, we reported for every complication the incidence range, the characteristics and the indications for the bronchoscopy.

On 107969 bronchoscopies, the incidence of complication of local anaesthesia was 0.3-0.5%; hypoxiaemia 0.2-21%; arrhythmia 1-10%; post-biopsy bleeding 0.12-7.5%; pneumothorax or pneumomediastinum 1-6%; fever 0.9-2.5%; death 0.1-0.2%. The majority of these complications were not life threatening.

Flexible bronchoscopy is an extremely safe procedure as long as some basic precautions are taken: complications incidence may be reduced by accurate patient selection, correct indication to bronchoscopy with an adequate anaesthesia or analgosedation and the correct endoscope. Is safe and useful virtual bronchoscopy in selected cases. Equipe cooperation and the responsibility of performing endoscopes are basilar. The gain of informed consensus is imperative before the bronchoscopy.