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Published on: July 19, 2024
The Utility of Endoscope-Assisted Rigid Bronchoscopy in Pediatric Airway Foreign Body Removals
Suleyman Ozdemir1, Ozgur Surmelioglu, Ozgur Tarkan
1Department of Otorhinolaryngology Head & Neck Surgery, Cukurova University School of Medicine, Adana, Turkey.
Insights
Pediatric foreign body aspiration is a critical emergency. Endoscope-assisted rigid bronchoscopy (RB) improves visualization, especially in young children, enhancing safety and reducing mortality for airway foreign body removal.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Pediatric Surgery
Background:
- Foreign body aspiration in children is a life-threatening emergency requiring rapid diagnosis and intervention.
- Children under 3 years are particularly vulnerable to fatal outcomes from airway foreign bodies.
Purpose of the Study:
- To evaluate the efficacy of endoscope-assisted rigid bronchoscopy (RB) in managing pediatric tracheobronchial foreign body emergencies.
- To reduce complications and mortality associated with foreign body aspiration in children.
Main Methods:
- A retrospective cross-sectional study analyzing 337 children with suspected airway foreign body aspiration.
- Patients were divided into two groups: Group 1 (endoscopy-assisted RB) and Group 2 (RB only).
- Surgeons completed surveys on the advantages and disadvantages of each procedure.
Main Results:
- Foreign bodies were identified in 77.1% of patients during RB.
- Complication rates, including transient hypoxia and bleeding, were similar between groups, with slightly lower incidence in the endoscope-assisted group.
- One patient in the RB-only group experienced fatal cardiac arrest; no long-term complications were observed.
Conclusions:
- Rigid bronchoscopy (RB) remains the gold standard for pediatric airway foreign body removal.
- Endoscope-assisted RB enhances visualization of distal bronchi and foreign bodies, particularly in children under 3.
- Endoscope-assisted RB is proposed to improve the safety of emergency airway foreign body removal in children.
Introduction:
Aspiration of foreign bodies is an emergency condition in children and may result in death, especially in children under 3 years of age. Therefore, diagnosis and treatment must be made rapidly.
Objective:
This study sought to summarize our experience with endoscope-assisted rigid bronchoscopy (RB) in the diagnosis and treatment of pediatric tracheobronchial foreign body emergencies to reduce complications and mortality.
Methods:
This was a retrospective cross-sectional study. The medical records of 337 children diagnosed with clinically suspected airway foreign body aspiration in the pediatric emergency department were analyzed retrospectively. The patients were divided into 2 groups with endoscopy used during RB in group 1 whereas group 2 was RB only. The surgeons who performed the bronchoscopies completed a survey on the advantages/disadvantages of these 2 procedures.
Results:
All of the patients had a positive history of suspected foreign body aspiration and foreign bodies were identified in 77.1% of the patients during RB. There were 161 (47.8%) patients in group 1 and 176 (52.2%) patients in group 2. In group 2, 5 patients showed transient hypoxia, and 6 patients had an episode of transient bleeding during the operations. These numbers were 3 and 3, respectively, in group 1. One patient in group 2 suffered cardiac arrest and died during surgery. The authors did not see any long-term complications after these operations and the authors did not find any statistically significant differences between the groups for complication rates.
Conclusion:
The RB is the gold standard procedure for removal of pediatric airway foreign bodies. The survey used in this study and our extensive experience have shown that the distal bronchi and foreign bodies can be visualized more effectively when using a rigid endoscope during RB, especially in children under the age of 3 years. In order to improve the safety of the surgical procedure, the authors propose that endoscope-assisted RB should be used in emergencies concerning foreign bodies in the airways of children.
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