Cambios en las indicaciones en la Unidad de Endoscopia Respiratoria del Hospital Universitario 12 de Octubre en los últimos años / Changes in the type of bronchoscopies in last years in the endoscopy respiratory unit of university hospital 12 octubre

Los objetivos de este trabajo son estudiar y valorar si han existido cambios en las indicaciones de broncoscopia en la Unidad de Endoscopia Respiratoria (UER) del Hospital Universitario (H.U.) 12 de Octubre en los últimos años, puesto que se han observado cambios epidemiológicos en distintas patologías respiratorias y se han incorporado nuevas técnicas endoscópicas. Por otra parte y dado que el trasplante pulmonar se introdujo en este hospital en el año 2008, también hemos valorado las diferencias en cuanto a las indicaciones de broncoscopia entre los pacientes sometidos a trasplante frente al resto en un segundo periodo de tiempo. Para realizar el estudio se ha utilizado la base de datos de la Unidad de Endoscopia Respiratoria del H.U. 12 de Octubre. Se han comparado pacientes de dos periodos de tiempo similares de 5 años: 2003-2008 vs. 2013-2018. En este último grupo se han valorado las diferencias entre los pacientes con trasplante pulmonar frente al resto. En los últimos cinco años se ha observado un mayor requerimiento de técnicas diagnósticas más complejas, una utilización mayoritaria de la sedación y un mayor número de pacientes en régimen hospitalario. Los pacientes con trasplante pulmonar tienen mayor necesidad de exploraciones urgentes y en régimen hospitalario, con mayor requerimiento de técnicas como la biopsia transbronquial y el lavado broncoalveolar. Por tanto como conclusión podemos decir que se han producido cambios en las indicaciones con una mayor complejidad en los últimos cinco años (AU)

Since epidemiologic changes regarding bronchogenic carcinoma had been related and new endoscopic techniques are available, one of the objectives of this study is evaluate the changes in bronchoscopy indications in the Unity of Respiratory Endoscopy of the H.U. 12 de Octubre. On the other hand, since lung transplantation has been introduced in H.U. 12 de Octubre in 2008, another objective is evaluate the differences related to bronchoscopy indication between patients with lung transplantation and not. We have used the database from the Unity of Respiratory Endoscopy of the H.U. 12 de Octubre. We have compared patients from two different periods: 2003-2008 (Period 1) and 2013-2018 (Period 2). We have also evaluated the differences between lung transplantation and not during period 2. Along the last five years we have related the following changes: a larger requirement of diagnostic techniques (TBP, BAL), a main use of sedation and a larger number of patients under hospital admission. As a conclusion, the bronchoscopy has become more complex. Patients with lung transplantation have more necessity of urgent examination under hospital admission and a larger request of specific techniques such as transbronchial biopsy and bronchoalveolar lavage. Therefore, this patients had entailed changes in the complexity if the bronchoscopy techniques in the last five years (AU)

Experiencia inicial en el diagnóstico de patologías distintas al carcinoma broncogénico por ecobroncoscopia / Non bronchogenic carcinoma diseases diagnosis by endobronchial ultrasound initial experience

La ecobroncoscopia es una técnica que ha demostrado su utilidad en el estudio y estadificación del carcinoma broncogénico. Su utilidad en otro tipo de lesiones, especialmente en procesos granulomatosos y linfoproliferativos es más discutida. Presentamos nuestra experiencia en el diagnóstico de este tipo de lesiones en los primeros meses de actividad en nuestro centro y una breve revisión de los últimos artículos publicados en esta línea (AU)

Endobronchial ultrasound is highly accurate procedure for the examination and staging of lung carcinoma. Its usefulness in other diseases like granulomatous and linfoproliferative illness is less clear. We show our initial experience in the diagnosis of these type of diseases and a short review of the recent articles published (AU)

¿Influye la experiencia del operador en la rentabilidad de la broncoscopia en el diagnóstico de lesiones pulmonares focales malignas? / Does the operator's experience influence the diagnostic profitability of the bronchoscopy in the diagnosis of malignant focal pulmonary lesions?

Introducción: La fibrobroncoscopia (FB) es una técnica de gran utilidad en el diagnóstico del nódulo pulmonar solitario (NPS) y de las masas pulmonares. La rentabilidad de la biopsia transbronquial (BTB) es variable y depende de distintos factores como la experiencia del operador. El objetivo del estudio fue determinar la rentabilidad de la BTB en el diagnóstico de la lesión pulmonar focal (LPF) maligna coincidiendo con la incorporación de dos nuevos médicos en nuestra Unidad sin experiencia previa en esta técnica, comparando los resultados con los datos previos de nuestro centro.Material y métodos: Se consideró LPF toda lesión pulmonar intraparenquimatosa bien circunscrita, rodeada de tejido pulmonar normal. Se incluyeron los pacientes remitidos desde febrero de 2008 a agosto de 2009 por una LPF (sin lesión endobronquial visible) y diagnóstico definitivo de malignidad. Se estudiaron 85 pacientes.Resultados: La rentabilidad diagnóstica de la BTB fue 0,55. La rentabilidad de la BTB fue mayor en lesiones > 2 cm (≤ 2 cm frente a > 2 cm; 0,38 frente a 0,62; p = 0,02) pero no hubo diferencias según la localización (central frente a periférica; 0,67 frente a 0,54; p = 0,16). La rentabilidad previa era de 0,76; sin diferencias según el tamaño (≤ 2 cm frente a > 2 cm; 0,72 frente a 0,78; p = 0,48), ni la localización (central frente a periférica; 0,83 frente a 0,74; p = 0,39).Conclusión: La experiencia del broncoscopista influye en la rentabilidad diagnóstica de la BTB en LPF malignas (AU)

Introduction: The fiberoptic bronchoscopy (FB) is a useful technique in the diagnosis of focal pulmonary nodules and masses. The profitability of the FB and transbronchial biopsy (TB) is variable and depends on different factors such as the operator's experience. The aim of this study was to determine if the diagnostic profitability of these techniques, in the diagnosis of malignant focal pulmonary lesions (FPL), changed with the incorporation of a new medical staff compared with previous data of our center. Material and methods: A FPL was defined as an intra ¿ parenchymatous pulmonary lesion that is well circumscribed and completely surrounded by healthy lung.We analyzed all the FBs between 02/2008 and 08/2009 in patients with a FPL with a definitive diagnosis of malignancy. 85 patients were included. Results: The diagnostic profitability of the TB was 0.55; it was higher when the FPL was > 2 cm (≤ 2 cm vs > 2 cm; 0.38 vs 0.62; p = 0.02) but no difference was found by site (central vs. peripheral; 0.67 vs 0.54; p = 0.16). The previous profitability of TB was 0.76 without differences by size (≤ 2cm vs > 2 cm; 0.72 vs 0,78; p = 0,48) or site (central vs peripheral; 0.83 vs 0.74; p = 0,39).Conclusion: We conclude that the operator's experience influences in the diagnostic profitability of the TB, in the malignant FPL (AU)

Metástasis endoluminales de la vía aérea en pacientes con melanoma maligno. Diagnóstico y tratamiento endoscópico / Endoluminal metastases of the airway in patients with malignant melanoma. Diagnosis and endoscopic treatment

Las metástasis endoluminales de la vía aérea por melanoma son bastante infrecuentes. Presentamos una serie de seis casos de metástasis en tráquea y árbol bronquial por melanoma maligno. De éstos, en cuatro casos se realizó una resección endoscópica y aplicación de láser por producir una obstrucción significativa de la vía aérea con síntomas asociados (AU)

Airway endoluminal Metastasis of malignant melanoma are rare. We present a group of six cases of metastatic malignant melanoma in trachea and bronchial tube, four of them required endoscopic resection and laser therapy to treat secondary symptomatic severe airway obstruction (AU)

Broncoscopia en cáncer de pulmón. ¿Hacia dónde vamos? / Bronchoscopy in lung cancer: Where are we going?

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Rentabilidad microbiológica del lavado broncoalveolar en la Unidad de Endoscopia Respiratoria del Hospital Universitario 12 de Octubre / Microbiological rentability of bronchoalveolar lavage at the Respiratory Endoscopic Unit of the Hospital Universitario 12 de Octubre

Introducción: Los objetivos fueron determinar la rentabilidad microbiológica del lavado broncoalveolar (LBA) e identificar los microorganismos que con mayor frecuencia se aislaron de acuerdo con las poblaciones de riesgo. Material y métodos: Se estudiaron todos los LBA entre enero de 2008 y diciembre de 2009. En todas las muestras se realizó el protocolo microbiológico (estudio de bacterias, hongos, micobacterias, virus y Pneumocystis jiroveci). Se recogieron variables sociodemográficas, prioridad de la indicación, servicio solicitante, resultados microbiológicos y complicaciones. Para el análisis estadístico se utilizó la prueba estadística de Chi cuadrado, considerando estadísticamente significativa una diferencia entre grupos p < 0,05. Resultados: Se efectuaron 244 LBA, de los que fueron positivos el 46,7% (bacterias 15,1%, hongos 16%, micobacterias 2,5%, virus 5,3% y Pneumocystis jiroveci 7,8%). Se dividió a la población en subgrupos de riesgo (trasplante de órgano sólido, infección por virus de la inmunodeficiencia humana [VIH] o sida, enfermedad pulmonar intersticial difusa con o sin tratamiento inmunosupresor, trastornos hematológicos, enfermedades reumatológicas con tratamiento inmunosupresor, enfermedad tumoral en tratamiento con quimioterapia o radioterapia), y se realizó un análisis de la rentabilidad diagnóstica del LBA en cada uno de ellos. El LBA en pacientes con infección por VIH o sida presentó una mayor frecuencia de virus, hongos y Pneumocystis jiroveci mientras que el LBA en pacientes con trastornos hematológicos presentó una mayor frecuencia de Pneumocystis jiroveci. En los otros subgrupos, no se encontraron diferencias. Conclusión: En la mitad de los LBA realizados se obtuvo un diagnóstico microbiológico definitivo. La enfermedad de base del paciente permite predecir la mayor probabilidad del germen responsable, principalmente en pacientes con VIH positivo y con enfermedades hematológicas (AU)

Introduction: The objectives of this study were to determine the microbiological diagnostic yield of the bronchoalveolar lavage (BAL) and to identify the most frequently isolated microorganisms according to the risk populations. Material and methods: All the BALs done between January 2008 and December 2009 were studied. The microbiological protocol was carried out for all the BAL samples (bacteria, fungus, mycobacteria, virus and Pneumocystis jiroveci). Social demographic data, priority of the procedure, unit that required the procedure, microbiological results and complications variables were noted. The Chi square statistical test was used, the results being considered as statistically significant when p <0 05 results: a total of 244 bals were done 46 7 which positive bacteria 15 1 fungus 16 mycobacteria 2 5 virus 3 and pneumocystis jiroveci 8 the population was divided into following risk subgroups: solid organ transplant hiv infection or aids diffuse interstitial lung disease with without immunosuppressant treatment hematologic diseases rheumatologic cancer chemotherapy radiotherapy an analysis bal microbiological diagnostic yield in each group those patients showed higher frequency while hematological no differences found other groups conclusion: almost half carried out final result medical background patient makes it possible to predict responsible germ greater likelihood especially (AU)

Experiencia de los últimos 17 años en una unidad de endoscopia respiratoria / Respiratory endoscoscopy department experience in the last 17 years

Objetivo. Describir la actividad de una de las primeras unidades de endoscopia respiratoria (UER) de nuestro país analizando las indicaciones y técnicas de broncoscopia diagnóstica y terapéutica, y si se han modificado a lo largo de los años. Material y métodos. Estudio transversal de todas las broncoscopias realizadas en nuestra UER desde 01/1992 hasta 05/2009. Para analizar la evolución de las indicaciones dividimos a la población general en cuatro poblaciones agrupadas por orden cronológico según la fecha de la exploración. Para analizar las diferencias en la frecuencia de las distintas técnicas a lo largo del tiempo empleamos el coeficiente Chi cuadrado de Pearson, aceptando como significativo un valor de p < 0,05. Resultados. 30.359 exploraciones (1.785 exploraciones/año); programadas 84,4% y urgentes 15,6%. De éstas, 26.277 (86,5%) fueron diagnósticas, 2.668 (8,8%) terapéuticas y 1.414 (4,6%) intubaciones. Se ha producido un descenso estadísticamente significativo del número de biopsias y cepillados bronquiales con un incremento significativo de las biopsias y punciones transbronquiales. Se han colocado 890 prótesis endoluminales y se han realizado tratamientos con láser en 429 casos. El porcentaje de complicaciones ha sido escaso (0,5%) y la tolerancia de los pacientes con anestesia local fue considerada buena en el 91,1% de casos. Conclusiones. El número de broncoscopias realizadas en nuestra UER es elevado, en especial las terapéuticas. Las indicaciones y técnicas realizadas se han modificado a lo largo de los años de acuerdo con la evolución de la técnica y los cambios de incidencia de diferentes patologías neumológicas (AU)

AIM. To describe the activity of one of the first Respiratory Endoscopy Departments in Spain, analyzing different techniques and indications of flexible and interventional bronchoscopy and its modifications over the years. Material and methods. Transversal study of all bronchoscopies carried out between 01/1992 and 05/2009. To analyze the different techniques along this period, the whole population was divided in four groups according to the date of the technique. The Pearson Chi square trend test was used for statistical comparisons, with p<0.05 considered to indicate a significant result. Results. 30,359 examinations (1,785 examination per year) were done; 84.4% programmed and 15.6% emergencies. For these 26,277 (86.5%) were diagnosis, 2,668 (8.8%) therapeutic and 1,414 (4.6%) intubations. There was a statistically significant decrease of bronchial biopsies and brushings and a statistically significant increase of transbronchial biopsies and punctures. 890 tracheobronchial endoprothesis were placed and 429 laser therapies were executed. Few complications were registered (0.5%) and thopic anaesthesia was well tolerated by most patients (91.1%). Conclusions. The global number of bronchoscopies done in our department is quiet large, especially therapeutic ones. Over the years, indications and different techniques have changed, according to technique evolution and different lung diseases (AU)

[Profitability of the bronchoscopy in the diagnosis of focal pulmonary malignant lesions]. / Rentabilidad de la broncoscopia en el diagnóstico de lesiones pulmonares focales malignas.

INTRODUCTION: We define focal pulmonary lesion (FPL) as an intra-parenchymatous pulmonary lesion that is well circumscribed and completely surrounded by healthy lung. It is considered that the profitability of the fine needle aspiration puncture (FNAP) in FPL < or = 2 cm is better than that of the fibrobronchoscopy (FBC). OBJECTIVE: To analyze the diagnostic profitability of the FNAP in the malignant FPL and study if it varies according to site, size and histology. MATERIAL AND METHODS: We analyzed all the FBCs of our Unit between 01/2000 and 12/2001 in patients with solitary FLP < or = 6 cm with a definitive diagnosis of malignancy. The diagnostic profitability by size, site and histology was analyzed with Pearson's chi(2) statistics. RESULTS: 124 patients. Mean FBC per patient was 1.3. A total of 101 cases (82%) were diagnosed with FBC, 15 by thoracotomy and 8 by FNAP. Global diagnostic profitability of the FBC was 0.82 and the transbronchial biopsy 0.76. There are no diagnostic profitability differences by size (< or = 2 cm vs > 2 cm) (0.81 vs 0.82 p = 0.96), site (peripheral vs central) (0.79 vs 0.85 p = 0.41) and histology (epidermoid vs adenocarcinoma) (0.89 vs 0.75 p = 0.21). CONCLUSION: Profitability of the FBC in malignant FPL in our hospital is elevated without differences by size, site or histology. In our site, the initial diagnostic approach of the FLP is done with FBC.

[Delays in the diagnosis and surgical treatment of bronchogenic carcinoma. Cooperative Group on Bronchogenic Carcinoma of SEPAR (GCCB-S)]. / Demoras en el diagnóstico y en el tratamiento quirúrgico del carcinoma broncogénico. Grupo Cooperativo de Carcinoma Broncogénico de SEPAR (GCCB-S).

The aim of this study was to determine the delay between clinical suspicion and diagnosis of bronchogenic carcinoma, and between diagnosis and performance of therapeutic thoracotomy. The study population included 598 patients undergoing surgery between October 1995 and September 1996 registered in the Bronchogenic Carcinoma Cooperation Group of SEPAR (BCCG-S), and 49 patients from our hospital undergoing surgery during the same period. The mean delay between diagnosis and thoracotomy was 45.15 days (SD 34.7 days) for BCCG-S patients and 53.5 days (SD 22 days) for our hospital patients. In the second group, mean time elapsing between diagnosis suspicion and performance of bronchoscopy was known to be 9.5 days (SD 14.7 days), with the lowest periods recorded for inpatients (3.1 +/- 1.7 days) and for patients who did not require chest x ray guided bronchoscopy (5 +/- 5.8 days). These data are similar to those published for hospitals in other countries. They must be considered long delays and should be shortened.

[Fiber optic bronchoscopy in extraction of tracheo-bronchial foreign bodies in adults]. / La fibrobroncoscopia en la extracción de cuerpos extraños traqueobronquiales en adultos.

The aim of this study was to determine the clinical, radiologic and endoscopic characteristics of adults with tracheobronchial foreign bodies (FB), and to review the role of fiberoptic bronchoscopy in extracting them. We reviewed the case histories and bronchoscopic reports for all patients over 14 years of age with FB treated between 1976 and 1995. Fifty-nine FB were removed from 56 patients; 68% were male and 48% were over 60 years of age. The most common clinical presentations were symptoms of respiratory infection and acute choking. In only in 28% could a risk factor for aspiration be identified. The X-ray was non specific and in 37% of cases the chest film was normal. In 66% FB aspiration was an unexpected endoscopic finding. The FB was removed from the right lung in 81.3%. FB were food items in 71% of cases. Fiberoptic bronchoscopy was useful for removal in 95% of cases, with few and unimportant complications. Two cases were resolved with rigid bronchoscopy and only one patient required surgery. FB aspiration is common and diagnosis is difficult in the adult. Fiberoptic bronchoscopy resolved most aspirations in adults with no important complications. The rigid bronchoscope should be reserved for very specific cases.

[Tracheobronchial granular-cell tumors. A report of 8 cases]. / Tumores de células granulares traqueobronquiales. Presentación de 8 casos.

To describe the clinical and radiologic signs, evolution and response to treatment of patients diagnosed of tracheobronchial granular cell tumors (GCT) in our practice. Retrospective computerized review of all bronchoscopic procedures performed in our hospital from January 1974 through November 1996. Patients with GCT were identified and their case histories reviewed. Eight male patients with 9 GCT were identified. Mean age was 55 years. Only one was symptomatic (hemoptysis) and only one had radiologic signs (solitary pulmonary node). Six patients were diagnosed of tumors in other organs. With the exception of one GCT located in the trachea, all were found in the right bronchial system. Endoscopy revealed mucosal abnormalities in six patients and nodes in three. Treatment was conservative in four patients, endoscopic in three (2 mechanical endoscopic resections and one laser Nd-YAG resection in a patient with two tumors), and surgical in one. Disease evolution as treated was favorable during the observation period. Tracheobronchial GCT are rare tumors. Most patients were between 50 and 70 years old, were often asymptomatic and had few radiologic manifestations. They suffered accompanying neoplasia in other organs. GCT were located in central and segmentary bronchial and nodes or abnormal mucosa could be seen endoscopically. Treatment was conservative, endoscopic or surgical, depending on tumor size and patient characteristics.

Safety of the transbronchial biopsy in outpatients.

The objective of our study was to determine the safety of transbronchial biopsy (TBB) in nonhospitalized patients. The design was a prospective study of the consecutive cases from July 1987 until September 1988 in the setting of a university hospital of the third level with 1,800 beds. The patients were a consecutive sample of 169 patients who had 184 procedures of fiberoptic bronchoscopy (FOB) with TBB performed. They suffered from different diseases: lung nodules or masses, diffuse interstitial disease, alveolar condensation, etc. An FOB with TBB was performed in immunocompetent outpatients, who were kept under observation for four hours and then had a chest roentgenogram taken afterwards. We contacted them again after 72 hours to rule out delayed complications. In three cases, more than 100 ml of blood were obtained during the FOB, without significant hemoptysis being recorded in those patients during the observation period; chest pain occurred in 15 patients during the TBB; pneumothorax occurred in two patients (1 percent), one of whom required admission to the hospital, without requiring chest tube drainage. Other complications are reported (bronchospasm, parenchymal hemorrhage, and pneumonia). In conclusion, we consider the TBB to be a technique with a low incidence of complications for outpatients, so therefore we do not believe that admission to the hospital is mandatory for this type of patient, although we do recommend a longer observation period.