An audit of fibre-optic bronchoscopy in a general hospital in sri lanka

Abstract

INTRODUCTION: In managing respiratory disease the indications for fibre-optic bronchoscopy (FOB) are many and arise not only from abnormal radiographic appearances but also from respiratory symptoms alone. A FOB service was established in the University Medical Unit of the Colombo North Teaching Hospital, Ragama, in February 2001. OBJECTIVES AND DESIGN: A prospective database was begun at inception to follow patient outcomes. The primary end point was the number of patients in whom FOB changed management. Data were collected to follow patterns of referral, indications, bronchoscopic findings, diagnostic procedures and outcome for all patients referred to the service. RESULTS: 54 patients (42 male) were bronchoscoped in the first 8 months of the service (1 refusal of consent). All were in-patients. Most referrals were made by physicians (49/55). The indication in 54/55 cases was an abnormal chest radiograph in addition to clinical features. 11/54 had normal FOB examinations. In 6 cases bronchogenic tumour was seen. 37 cases had inflammatory changes: with blood in 22 (excluding those with tumour) and muco-purulent secretions in 16 (both features in 12 cases). Diagnostic procedures were carried out in all but 4 cases: bronchial wash for microbiology in 36 cases, cytology 32 (both in 18) and endobronchial biopsy 10. OUTCOME: From 54 bronchoscopies, 6 cases of bronchial malignancy were confirmed by pathology (4 biopsy, 2 cytology) and 18 cases of tuberculosis were confirmed by Ziehl-Neelson staining of aspirate. CONCLUSIONS: Overall, FOB enabled a definitive on-site pathological diagnosis to be reached in 24 cases (44%), reducing the need for patient transfer.