If your child has an obstruction in the airway due to tumors, plastic bronchitis, bronchial casts or inhaled foreign bodies, advances in flexible bronchoscopy technology now allow for minimally invasive alternatives to surgery.
In flexible interventional bronchoscopy, a pulmonologist inserts a thin, bendable tube called a bronchoscope through your child’s mouth or nose and into the lungs. A light and a small camera on the bronchoscope allow the doctor to look inside the lungs and air passages. The tube can also hold instruments for additional tasks, as needed to help your child.
Types of flexible interventional bronchoscopy techniques for diagnosis and treatment include:
- Cryobronchoscopy
- Remove foreign bodies, plastic bronchitis (cryoextraction)
- Widen airway stenosis (cryodevitalization)
- Extract a piece of tissue (cryobiopsy)
- Endobronchial tumor management
- Biopsy
- Excision/debulking
- Tracheoesophageal fistula nonsurgical repair
- Balloon dilation for bronchial stenosis (narrowing)
- Endobronchial one-way valves for persistent air leak/pneumothorax
- Whole lung lavage for pulmonary alveolar proteinosis (PAP)
Cryobronchoscopy
Cryotechnology — using very low temperatures to destroy abnormal tissues, such as tumors — has been adapted for use in flexible bronchoscopy. It provides effective ways to remove foreign bodies, mucus plugs and bronchial casts caused by plastic bronchitis from the airways in children. This is called cryoextraction.
These tools are safe and can be far more effective and faster than using standard instruments (such as suction, forceps or baskets). They can also be used to treat bronchial narrowing (cryodevitalization) and to obtain tissue samples (cryobiopsy).
Endobronchial tumor management
Tumors and masses of the trachea and bronchi are very rare in children. It is critical to determine the exact type of tumor — and whether it is cancerous or is a mass caused by infections or inflammatory conditions — to spare the child unnecessary treatment. Flexible and rigid bronchoscopy techniques allow our experts to snip a tiny bit of tumor tissue (biopsy) to determine the cause of the mass. This guides treatment planning and next steps.
If the biopsy shows the child has one of the more common types of cancerous airway tumors, such carcinoid tumors, inflammatory myofibroblastic tumors and mucoepidermoid carcinomas, CHOP has a uniquely experienced multidisciplinary team to help. The team includes specialists in pulmonology, ENT, cardiothoracic surgery, oncology, radiology and pathology and offers state-of-the-art approaches to minimally invasive diagnosis and lung-sparing surgical treatments.
Sometimes, complete removal of certain types of tumors is possible using flexible and/or rigid bronchoscopy. Once the diagnosis is confirmed, your child will be offered the most appropriate lung-sparing surgical options and, if necessary, they will receive targeted chemotherapy.
Nonsurgical treatment of tracheoesophageal fistula
Tracheoesophageal fistulas (TEF) are abnormal connections (holes or tunnels) between the trachea (windpipe) and esophagus (food pipe). They may be present at birth (congenital) or develop later in childhood. Most children with tracheoesophageal fistulas are also born with esophageal atresia (abnormal development of the esophagus).
Traditionally, a child needs surgery to repair the TEF. However, when there is only a TEF and no esophageal atresia, we can use nonsurgical techniques. A combination of bronchoscopy and endoscopy can close the abnormal connection.
Instruments can be inserted into the flexible bronchoscope and endoscope to carefully and precisely deliver an electrical current that causes the hole to scar closed. Specially designed clips can also be used to help keep the hole closed.
Our pulmonary specialists partner with experts in gastroenterology, ENT and pediatric surgery to offer endoscopic TEF repair through the Esophageal and Airway Treatment (EAT) Program.
Balloon dilation for bronchial narrowing (stenosis)
Your child may experience bronchial narrowing (stenosis) at birth or develop it later in childhood due to infections or injuries that cause scaring inside the bronchial tubes. These narrow bronchial tubes can often be treated with specially designed balloon catheters that stretch and expand the airway. This is sometimes used together with cryotechnology to freeze the scar and prevent it from returning.
Endobronchial valves for persistent air leak or nonsurgical lung volume reduction
If your child has a persistent air leak (pneumothorax), endobronchial one-way valves can be inserted into the airway to stop the leak and allow for removal of the chest tube that would otherwise be required to drain the air. These valves can also be used as a nonsurgical alternative to lung volume reduction surgery (lobar emphysema). The valves were originally developed for adults with severe lung problems. Our team has adapted the technology to use in select cases for infants and children.
More techniques planned
Even with these advances, our work is not done. The Pulmonary Advanced Diagnostic and Interventional Bronchoscopy Center team is committed to advancing and developing new ways to diagnose and treat lung disease in children. We will add additional techniques as they become available. We are also committed to training the next generation of pediatric pulmonologists to expand the field of advanced diagnostic and interventional bronchoscopy.