Removal of tracheobronchial foreign bodies in adults using a flexible bronchoscope: experience with 200 cases in China.

OBJECTIVE Tracheobronchial foreign bodies (FBs) are frequently present in adults. This study reports our experience with the managements of FB and FB-related complications using flexible bronchoscopy. METHODS We retrospectively reviewed the adult patients with FBs treated between 2001 and 2011 in China. The demographic and endoscopic data were collected and analyzed. RESULTS A total of 200 adult patients (136 men and 64 women) with an average age of 51 years were analyzed. The most common FBs included bones (51.0%), nut shells (15.0%), food boluses (7.0%), plastic toys or pen caps (6.5%). After FB aspiration occurred, only 11.0% were diagnosed within three days, while more than half of the patients (58.0%) delayed the diagnosis by more than one month. The incidence of FB-related complications was 79.5%, including granulation formation (76.5%), obstructive pneumonia (22.0%), hemorrhage (14.5%), atelectasis (10.0%) and endobronchial stenotic scarring (8.0%). In 96.5% of the patients, the FBs were successfully removed under flexible bronchoscopy. A total of 53 out of the 153 patients with granulation (34.6%) were managed by argon plasma coagulation (APC) or cryotherapy; two out of the sixteen patients with endobronchial stenotic scars were treated by balloon dilation under flexible bronchoscopy. CONCLUSION A high incidence of FB-related complications occurs, likely as a result of the long delay between aspiration and diagnosis, a proportion of which require endoscopic intervention. The removal of FBs under flexible bronchoscopy has a high success rate and therefore should be recommended for adults.

[1]  Y. Aelony,et al.  Endobronchial foreign bodies in Vietnamese adults are related to eating habits , 2010, Respirology.

[2]  L. Tang,et al.  Airway foreign body removal by flexible bronchoscopy: experience with 1027 children during 2000–2008 , 2009, World journal of pediatrics : WJP.

[3]  S. Janković,et al.  Removal of tracheobronchial foreign bodies in adults using flexible bronchoscopy: experience 1995–2006 , 2008, Surgical Endoscopy.

[4]  H. Ulutas,et al.  Tracheobronchial foreign body aspiration: A continuing challenge , 2006, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[5]  J Strausz,et al.  Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents , 2006, European Respiratory Journal.

[6]  S. Neves,et al.  Tracheobronchial foreign bodies in adults--experience of the Bronchology Unit of Centro Hospitalar de Vila Nova de Gaia. , 2006, Revista portuguesa de pneumologia.

[7]  U. Hamza,et al.  Inhaled foreign bodies: management according to early or late presentation. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[8]  J. Strausz,et al.  ERS/ATS statement on interventional pulmonology , 2002, European Respiratory Journal.

[9]  J Strausz,et al.  ERS/ATS statement on interventional pulmonology. European Respiratory Society/American Thoracic Society. , 2002, The European respiratory journal.

[10]  E. Mušič,et al.  Bronchoscopic removal of foreign bodies in adults: experience with 62 patients from 1974-1998. , 1999, The European respiratory journal.

[11]  D. Rodenstein,et al.  Tracheobronchial foreign bodies: presentation and management in children and adults. , 1999 .

[12]  E. J. Mark,et al.  Case 33-1997 , 1997 .

[13]  K. Al-kattan,et al.  Overlooked inhaled foreign bodies: late sequelae and the likelihood of recovery. , 1997, Respiratory medicine.

[14]  Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 33-1997. A 75-year-old man with chest pain, hemoptysis, and a pulmonary lesion. , 1997, The New England journal of medicine.

[15]  P. Mathur,et al.  Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. , 1996, Chest.

[16]  T. Chao,et al.  Bronchial foreign bodies in adults. , 1996, Journal of the Formosan Medical Association = Taiwan yi zhi.

[17]  R. Lan.  Non-asphyxiating tracheobronchial foreign bodies in adults. , 1994, The European respiratory journal.

[18]  T. Moisan.  Retained endobronchial foreign body removal facilitated by steroid therapy of an obstructing, inflammatory polyp. , 1991, Chest.

[19]  A. Limper,et al.  Tracheobronchial foreign bodies in adults. , 1990, Annals of internal medicine.

[20]  K. Mantel,et al.  Tracheobronchial foreign body aspiration in childhood. A report on 224 cases. , 1986, European journal of pediatrics.

[21]  P. Beuchat.  [Tracheobronchial foreign body aspiration in childhood]. , 1970, Schweizerische Rundschau fur Medizin Praxis = Revue suisse de medecine Praxis.