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Fumihiro Asano - One of the best experts on this subject based on the ideXlab platform.
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Use of an Ultrathin vs Thin Bronchoscope for Peripheral Pulmonary Lesions: A Randomized Trial.
Chest, 2019Co-Authors: Masahide Oki, Fumihiro Asano, Hideo Saka, Chiyoe Kitagawa, Yoshihito Kogure, Akifumi Tsuzuku, Masahiko AndoAbstract:Background When evaluating peripheral pulmonary lesions, a 3.0-mm ultrathin Bronchoscope (UTB) with a 1.7-mm working channel is advantageous regarding good access to the peripheral airway, whereas a 4.0-mm thin Bronchoscope provides a larger 2.0-mm working channel, which allows the use of various instruments including a guide sheath (GS), larger forceps, and an aspiration needle. This study compared multimodal bronchoscopy using a UTB and a thin Bronchoscope with multiple sampling methods for the diagnosis of peripheral pulmonary lesions. Methods Patients with peripheral pulmonary lesions ≤ 30 mm in diameter were recruited and randomized to undergo endobronchial ultrasonography, virtual bronchoscopy, and fluoroscopy-guided bronchoscopy using a 3.0-mm UTB (UTB group) or a 4.0-mm thin Bronchoscope (thin Bronchoscope group). In the thin Bronchoscope group, the use of small forceps with a GS or standard forceps without the GS was permitted. In addition, needle aspiration was performed for lesions into which an ultrasound probe could not be inserted. Results A total of 360 patients were enrolled, and 356 were included in the analyses (median largest lesional diameter, 19 mm). The overall diagnostic yield was significantly higher in the UTB group than in the thin Bronchoscope group (70.1% vs 58.7%, respectively; P = .027). The procedure duration was significantly shorter in the UTB group (median, 24.8 vs 26.8 min, respectively; P = .008). The complication rates were 2.8% and 4.5%, respectively (P = .574). Conclusions Multimodal bronchoscopy using a UTB afforded a higher diagnostic yield than that using a thin Bronchoscope in the diagnosis of small peripheral pulmonary lesions. Trial Registry UMIN Clinical Trials Registry; No.: UMIN000010133; URL: https://www.umin.ac.jp/ctr/
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Advanced bronchoscopy for the diagnosis of peripheral pulmonary lesions.
Respiratory investigation, 2016Co-Authors: Fumihiro AsanoAbstract:Abstract Bronchoscopy to examine peripheral pulmonary lesions is performed using a Bronchoscope with an outer diameter of 5–6mm under fluoroscopy, but the diagnostic yield can be insufficient. Problems with transbronchial biopsy include a limited range of Bronchoscope insertion, difficulty in guiding a Bronchoscope and biopsy instruments to lesions, and insufficient confirmation of the arrival of biopsy instruments at the target lesion; as such, new techniques have been used to overcome these individual problems. Radial-endobronchial ultrasound is used to identify peripheral pulmonary lesions and sampling sites. In a meta-analysis, the diagnostic yield, that of lesions smaller than 2cm, and complication rate were 73, 56.3, and 1.0%, respectively. Virtual bronchoscopic navigation is a method to guide a Bronchoscope to peripheral lesions under direct vision using virtual bronchoscopic images of the bronchial route, and the diagnostic yield, that of 2-cm or smaller lesions, and complication rate were 73.8, 67.4, and 1.0%, respectively. Electromagnetic navigation utilizes electromagnetism; the diagnostic yield was 64.9–71%, and the pneumothorax complication rate was 4% for this modality. Ultrathin Bronchoscopes can be advanced to the peripheral bronchus under direct vision in contrast to normal-size Bronchoscopes, and the diagnostic yield and pneumothorax complication rates were reported to be 63 and 1.5%, respectively. The overall diagnostic yield of these new techniques on meta-analysis was 70%, a higher yield than that obtained with conventional transbronchial biopsy. Each technique has advantages and disadvantages, and the investigation of appropriate combinations corresponding to individual cases is necessary.
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a virtual bronchoscopic navigation system for pulmonary peripheral lesions
Chest, 2006Co-Authors: Fumihiro Asano, Yoshihiko Matsuno, Naofumi Shinagawa, Koichi Yamazaki, Toshitaka Suzuki, Takashi Ishida, Hiroshi MoriyaAbstract:Study objectives We performed ultrathin bronchoscopy for pulmonary peripheral lesions using a system that displays virtual bronchoscopy (VB) images to the lesion simultaneously with actual images and navigates the Bronchoscope to the target bronchus. We then evaluated the system with regard to its usefulness and problems. Design A pilot study. Setting A tertiary teaching hospital. Patients The subjects were consecutive patients with small pulmonary peripheral lesions (≤ 30 mm). Interventions Using this system, the rotation, advancement, and retreat of VB images were possible, and the bronchus into which the Bronchoscope was to be advanced was displayed. VB images were displayed along with actual images, and the ultrathin Bronchoscope was advanced to the target bronchus under direct vision. Under CT and radiographic fluoroscopy, a pair of forceps was inserted into the lesion via the Bronchoscope. Thin-section CT images were obtained; after confirming the advancement of the Bronchoscope into the target bronchus and the arrival of the forceps at the lesion, a biopsy was performed. Results Study subjects included 37 patients with 38 lesions. VB images to a median of the sixth- (third- to ninth-) order bronchi could be produced. Using this system, the ultrathin Bronchoscope could be advanced into the planned route for 36 of the 38 lesions (94.7%). The system was used for a median of 2.6 min, and the median examination time was 24.9 min. The biopsy forceps could be advanced to the lesion in 33 of the 38 lesions (86.8%), and diagnosis was possible for 31 lesions (81.6%). Conclusions This navigation system is useful for ultrathin bronchoscopy for pulmonary peripheral lesions.
Bernard Floccard - One of the best experts on this subject based on the ideXlab platform.
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Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated Bronchoscope suction valves, Lyon, France, 2014.
Eurosurveillance, 2016Co-Authors: Marine Guy, Philippe Vanhems, Cédric Dananché, Michel Perraud, Anne Regard, Monique Hulin, Olivier Dauwalder, Xavier Bertrand, Jullien Crozon-clauzel, Bernard FloccardAbstract:In April 2014, pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia co-infections potentially related to bronchoscopic procedures were identified in the intensive care units of a university hospital in Lyon, France. A retrospective cohort of 157 patients exposed to Bronchoscopes from 1 December 2013 to 17 June 2014 was analysed. Environmental samples of suspected endoscopes were cultured. Bronchoscope disinfection was reviewed. Ten cases of pulmonary P. aeruginosa/S. maltophilia co-infections were identified, including two patients with secondary pneumonia. Eight cases were linked to Bronchoscope A1 and two to Bronchoscope A2. Cultures deriving from suction valves were positive for P. aeruginosa/S. maltophilia. Exposure to Bronchoscopes A1 and A2 was independently coupled with increased risk of co-infection (adjusted odds ratio (aOR) = 84.6; 95% confidence interval (CI): 9.3-771.6 and aOR = 11.8, 95% CI: 1.2-121.3). Isolates from suction valves and clinical samples presented identical pulsotypes. The audit detected deficiencies in endoscope disinfection. No further cases occurred after discontinuation of the implicated Bronchoscopes and change in cleaning procedures. This outbreak of pulmonary P. aeruginosa/S. maltophilia co-infections was caused by suction valve contamination of two Bronchoscopes of the same manufacturer. Our findings underscore the need to test suction valves, in addition to Bronchoscope channels, for routine detection of bacteria.
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Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated Bronchoscope suction valves, Lyon, France, 2014.
Eurosurveillance, 2016Co-Authors: Philippe Vanhems, Cédric Dananché, Michel Perraud, Anne Regard, Monique Hulin, Olivier Dauwalder, Xavier Bertrand, Jullien Crozon-clauzel, Bernard FloccardAbstract:In April 2014, pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia co-infections potentially related to bronchoscopic procedures were identified in the intensive care units of a university hospital in Lyon, France. A retrospective cohort of 157 patients exposed to Bronchoscopes from 1 December 2013 to 17 June 2014 was analysed. Environmental samples of suspected endoscopes were cultured. Bronchoscope disinfection was reviewed. Ten cases of pulmonary P. aeruginosa/S. maltophilia co-infections were identified, including two patients with secondary pneumonia. Eight cases were linked to Bronchoscope A1 and two to Bronchoscope A2. Cultures deriving from suction valves were positive for P. aeruginosa/S. maltophilia. Exposure to Bronchoscopes A1 and A2 was independently coupled with increased risk of co-infection (adjusted odds ratio (aOR) = 84.6; 95% confidence interval (CI): 9.3-771.6 and aOR = 11.8, 95% CI: 1.2-121.3). Isolates from suction valves and clinical samples presented identical pulsotypes. The audit detected deficiencies in endoscope disinfection. No further cases occurred after discontinuation of the implicated Bronchoscopes and change in cleaning procedures. This outbreak of pulmonary P. aeruginosa/S. maltophilia co-infections was caused by suction valve contamination of two Bronchoscopes of the same manufacturer. Our findings underscore the need to test suction valves, in addition to Bronchoscope channels, for routine detection of bacteria.
Atul C. Mehta - One of the best experts on this subject based on the ideXlab platform.
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Bronchoscope-Related “Superbug” Infections
Chest, 2019Co-Authors: Atul C. Mehta, Lawrence F. MuscarellaAbstract:Several recent cases associating cleaned and high-level disinfected duodenoscopes with outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) and related multidrug-resistant organisms (MDROs) may cause bronchoscopists, pulmonologists, and other stakeholders to inquire about the effectiveness of today's practices for reprocessing flexible Bronchoscopes. The primary objectives of this study were to address this question and investigate the risk of Bronchoscopes transmitting infections of CRE and related MDROs. The published literature and the US Food and Drug Administration's medical device database of adverse events were searched beginning in 2012, when endoscopy first emerged as a recognized risk factor for transmission of CRE. The Internet was also searched during this same time frame to identify other relevant cases. Several cases associating reprocessed Bronchoscopes with infections of CRE or a related MDRO were identified. This study's findings suggest that Bronchoscopes may pose an underrecognized potential for transmission of CRE and related MDROs, warranting greater public awareness, enhanced preventive measures, and updated reprocessing guidance. This study's data also suggest that the cleaning and high-level disinfection of Bronchoscopes performed in accordance with published guidelines and manufacturer instructions may not always be sufficiently effective to eliminate this risk. Several factors were identified that can adversely affect a Bronchoscope's reprocessing and pose a risk of transmission of these multidrug-resistant bacteria, including use of a damaged or inadequately serviced Bronchoscope, and formation of an inaccessible biofilm. Recommendations are provided to improve the safety of flexible Bronchoscopes, including supplementing their reprocessing with an enhanced measure such as sterilization when warranted, and strict adherence to a periodic servicing and maintenance schedule consistent with the Bronchoscope manufacturer's instructions.
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history of bronchoscopy the evolution of interventional pulmonology
2018Co-Authors: Michael Ghobrial, Tanmay S Panchabhai, Atul C. MehtaAbstract:The era of bronchoscopy began in 1876 with Gustav Killian inserting an esophagoscope into a farmer’s airway to remove a piece of a pork bone. Today that procedure of bronchoscopy has evolved into a super-specialty of interventional pulmonology. Several innovators, scientists, and physicians have made invaluable contribution in bringing the procedure of bronchoscopy to its current eminence. Flexible bronchoscopy has opened the doors for number of minimally invasive procedures improving the welfare of our patients. Interventional pulmonologists and the thoracic surgeons are teaming up to expand and exploit the boundaries of bronchoscopy to innovate safe and cost-effective diagnostic and therapeutic modalities. Today there remains no single pulmonary ailment that cannot be either diagnosed, palliated, or cured with the help of a Bronchoscope. In this chapter we describe the odyssey of bronchoscopy, highlighting its historical milestones and current status, and make humble predictions on the future potentials.
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Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images: the first human study.
Chest, 2006Co-Authors: Yehuda Schwarz, Joel Greif, Heinrich D. Becker, Armin Ernst, Atul C. MehtaAbstract:Study objectives: To characterize the feasibility, accuracy, and safety of the superDimension/ Bronchus system (SDBS) [superDimension, Ltd; Hertzliya, Israel] in navigating to previously unreachable peripheral lung lesions and obtaining biopsy specimens. Design: Open-label, prospective, controlled clinical study. Setting: Pulmonary institute of a university-affiliated municipal hospital. Patients: Thirteen adult candidates for nonemergency bronchoscopy who gave informed consent to participate. Interventions: The patients underwent flexible bronchoscopy using the SDBS, which is based on real-time CT-guided electromagnetic navigation and is capable of reaching peripheral lung masses beyond the reach of the Bronchoscope. A position sensor was used to navigate to and sample the various target lesions for biopsy. Measurements and results: Three-dimensional chest CT was followed by SDBS methodology for marking anatomic landmarks and the target lesion on a virtual bronchoscopy screen and for sampling the lesion. The SDBS assisted in obtaining positive biopsy diagnoses in 9 of 13 cases (69%), with an average navigation accuracy of 5.7 mm. There were no SDBS-related adverse events. Conclusions: The SDBS is safe and effective in navigating to peripheral lung lesions located beyond the optic limits of a standard flexible Bronchoscope. (CHEST 2006; 129:988–994)
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High Price of Bronchoscopy: Cost of Maintenance and Repair of Flexible Bronchoscopes
Journal of Bronchology, 2005Co-Authors: Arti J. Choure, Effrosyni D. Manali, Georgiann Krizmanich, Thomas R. Gildea, Atul C. MehtaAbstract:Abstract:Bronchoscopy is performed with either a fiberoptic (FS) or video Bronchoscope (VERSUS). We analyzed the cost of maintenance and repair of Bronchoscopes in our setting comparing FS versus VERSUS, preventable versus unpreventable damages, and repair charges by the manufacturer versus independ
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Reprocessing the Bronchoscope: the challenges.
Seminars in respiratory and critical care medicine, 2004Co-Authors: Majid M. Mughal, Omar A. Minai, Daniel A. Culver, Atul C. MehtaAbstract:Spread of infection through the flexible Bronchoscope is underrecognized and underreported. Prevention of bronchoscopy-induced infection requires increased vigilance by the physician, assiduous implementation of reprocessing protocols, and closer collaboration between bronchoscopy personnel, infection control practitioners, and instrument manufacturers. Patient safety depends on adequate disinfection of Bronchoscopes and accessories used, as well as proper training of bronchoscopists, nurses, and ancillary staff. It is important to recognize that microbial transmission may occur via any part of instruments or anything in contact with the instruments including cleaning solutions, automated washers, and rinsing water. Numerous surveys have suggested poor adherence to published preventive guidelines. To address the challenges of reprocessing Bronchoscopes, all users must comply with guidelines for cleaning and disinfection and each procedure should be performed with a clean, disinfected Bronchoscope.
Philippe Vanhems - One of the best experts on this subject based on the ideXlab platform.
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Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated Bronchoscope suction valves, Lyon, France, 2014.
Eurosurveillance, 2016Co-Authors: Philippe Vanhems, Cédric Dananché, Michel Perraud, Anne Regard, Monique Hulin, Olivier Dauwalder, Xavier Bertrand, Jullien Crozon-clauzel, Bernard FloccardAbstract:In April 2014, pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia co-infections potentially related to bronchoscopic procedures were identified in the intensive care units of a university hospital in Lyon, France. A retrospective cohort of 157 patients exposed to Bronchoscopes from 1 December 2013 to 17 June 2014 was analysed. Environmental samples of suspected endoscopes were cultured. Bronchoscope disinfection was reviewed. Ten cases of pulmonary P. aeruginosa/S. maltophilia co-infections were identified, including two patients with secondary pneumonia. Eight cases were linked to Bronchoscope A1 and two to Bronchoscope A2. Cultures deriving from suction valves were positive for P. aeruginosa/S. maltophilia. Exposure to Bronchoscopes A1 and A2 was independently coupled with increased risk of co-infection (adjusted odds ratio (aOR) = 84.6; 95% confidence interval (CI): 9.3-771.6 and aOR = 11.8, 95% CI: 1.2-121.3). Isolates from suction valves and clinical samples presented identical pulsotypes. The audit detected deficiencies in endoscope disinfection. No further cases occurred after discontinuation of the implicated Bronchoscopes and change in cleaning procedures. This outbreak of pulmonary P. aeruginosa/S. maltophilia co-infections was caused by suction valve contamination of two Bronchoscopes of the same manufacturer. Our findings underscore the need to test suction valves, in addition to Bronchoscope channels, for routine detection of bacteria.
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Outbreak of pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia infections related to contaminated Bronchoscope suction valves, Lyon, France, 2014.
Eurosurveillance, 2016Co-Authors: Marine Guy, Philippe Vanhems, Cédric Dananché, Michel Perraud, Anne Regard, Monique Hulin, Olivier Dauwalder, Xavier Bertrand, Jullien Crozon-clauzel, Bernard FloccardAbstract:In April 2014, pulmonary Pseudomonas aeruginosa and Stenotrophomonas maltophilia co-infections potentially related to bronchoscopic procedures were identified in the intensive care units of a university hospital in Lyon, France. A retrospective cohort of 157 patients exposed to Bronchoscopes from 1 December 2013 to 17 June 2014 was analysed. Environmental samples of suspected endoscopes were cultured. Bronchoscope disinfection was reviewed. Ten cases of pulmonary P. aeruginosa/S. maltophilia co-infections were identified, including two patients with secondary pneumonia. Eight cases were linked to Bronchoscope A1 and two to Bronchoscope A2. Cultures deriving from suction valves were positive for P. aeruginosa/S. maltophilia. Exposure to Bronchoscopes A1 and A2 was independently coupled with increased risk of co-infection (adjusted odds ratio (aOR) = 84.6; 95% confidence interval (CI): 9.3-771.6 and aOR = 11.8, 95% CI: 1.2-121.3). Isolates from suction valves and clinical samples presented identical pulsotypes. The audit detected deficiencies in endoscope disinfection. No further cases occurred after discontinuation of the implicated Bronchoscopes and change in cleaning procedures. This outbreak of pulmonary P. aeruginosa/S. maltophilia co-infections was caused by suction valve contamination of two Bronchoscopes of the same manufacturer. Our findings underscore the need to test suction valves, in addition to Bronchoscope channels, for routine detection of bacteria.
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Outbreaks of contaminated broncho-alveolar lavage related to intrinsically defective Bronchoscopes.
The Journal of hospital infection, 2005Co-Authors: Jean-charles Cetre, Marie-christine Nicolle, H. Salord, M. Pérol, S. Tigaud, G. David, M. Bourjault, Philippe VanhemsAbstract:Summary From 5 March 2001 to 19 October 2001, outbreaks of broncho-alveolar lavage (BAL) contamination with Enterobacteraceae were detected in our 700-bed institution. We report the investigation of these outbreaks. A case was defined as the occurrence of pairs of specific Enterobacteraceae in BAL specimens among any patients who underwent bronchoscopy in the respiratory unit during the period of the outbreak. Contamination was identified in 117 BAL samples during three outbreaks among 418 patients, and was associated with Bronchoscopes 11 and 12 ( P Klebsiella pneumoniae/Proteus vulgaris with Bronchoscope 11, and Morganella morganii/Proteus mirabilis with Bronchoscope 12). Cultures of sputa from two patients also yielded M. morganii some days after bronchoscopic examination. Isolates from contaminated BAL samples and Bronchoscope 11 had similar patterns by pulsed-field gel electrophoresis. No further cases occurred after removal of the implicated Bronchoscopes. No deficiencies in disinfection procedures were detected and the source of contamination was found to be a loose port of the biopsy channel of the Bronchoscope. Our findings underscore the urgent need to test bronchoscopic samples regularly and to improve the design and structure of Bronchoscopes.
Masahide Oki - One of the best experts on this subject based on the ideXlab platform.
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Use of an Ultrathin vs Thin Bronchoscope for Peripheral Pulmonary Lesions: A Randomized Trial.
Chest, 2019Co-Authors: Masahide Oki, Fumihiro Asano, Hideo Saka, Chiyoe Kitagawa, Yoshihito Kogure, Akifumi Tsuzuku, Masahiko AndoAbstract:Background When evaluating peripheral pulmonary lesions, a 3.0-mm ultrathin Bronchoscope (UTB) with a 1.7-mm working channel is advantageous regarding good access to the peripheral airway, whereas a 4.0-mm thin Bronchoscope provides a larger 2.0-mm working channel, which allows the use of various instruments including a guide sheath (GS), larger forceps, and an aspiration needle. This study compared multimodal bronchoscopy using a UTB and a thin Bronchoscope with multiple sampling methods for the diagnosis of peripheral pulmonary lesions. Methods Patients with peripheral pulmonary lesions ≤ 30 mm in diameter were recruited and randomized to undergo endobronchial ultrasonography, virtual bronchoscopy, and fluoroscopy-guided bronchoscopy using a 3.0-mm UTB (UTB group) or a 4.0-mm thin Bronchoscope (thin Bronchoscope group). In the thin Bronchoscope group, the use of small forceps with a GS or standard forceps without the GS was permitted. In addition, needle aspiration was performed for lesions into which an ultrasound probe could not be inserted. Results A total of 360 patients were enrolled, and 356 were included in the analyses (median largest lesional diameter, 19 mm). The overall diagnostic yield was significantly higher in the UTB group than in the thin Bronchoscope group (70.1% vs 58.7%, respectively; P = .027). The procedure duration was significantly shorter in the UTB group (median, 24.8 vs 26.8 min, respectively; P = .008). The complication rates were 2.8% and 4.5%, respectively (P = .574). Conclusions Multimodal bronchoscopy using a UTB afforded a higher diagnostic yield than that using a thin Bronchoscope in the diagnosis of small peripheral pulmonary lesions. Trial Registry UMIN Clinical Trials Registry; No.: UMIN000010133; URL: https://www.umin.ac.jp/ctr/
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novel thin Bronchoscope with a 1 7 mm working channel for peripheral pulmonary lesions
European Respiratory Journal, 2008Co-Authors: Masahide Oki, Hideo Saka, Chiyoe Kitagawa, S Tanaka, T Shimokata, K Mori, Shigehisa KajikawaAbstract:In the present study, the authors evaluated the diagnostic utility of a novel thin Bronchoscope with a 1.7-mm working channel for peripheral pulmonary lesions. A total of 118 patients were included in this prospective study. Bronchoscopic examination was performed using a 5.9-mm standard Bronchoscope. If no visible endobronchial lesion was found, transbronchial biopsies were performed with 1.5-mm biopsy forceps under fluoroscopic guidance and the bronchus were washed with 10-20 mL of saline solution, using a prototype 3.5-mm thin Bronchoscope with a 1.7-mm working channel. Endobronchial lesion was visualised with the standard Bronchoscope in 16 patients, and the other 102 patients underwent biopsies with the thin Bronchoscope. The mean bronchus levels reached with the standard Bronchoscope and the thin Bronchoscope were 2.3 and 4.3 generations, respectively. Endobronchial abnormality was revealed with the thin Bronchoscope in a further 14 patients. Diagnostic material was obtained in 50 of 68 (74%) patients with malignant disease and 18 of 30 (60%) patients with benign disease. Four patients did not return to follow-up. The diagnostic yield was 57%, even in lesions <20 mm. There were no major complications. In conclusion, bronchoscopy using a 3.5-mm thin Bronchoscope with a 1.7-mm working channel is useful and safe for the diagnosis of peripheral pulmonary lesions.
