Flexible Bronchoscopy As the First-Line Strategy for Extraction of Tracheobronchial Foreign Bodies>

Introduction: Foreing body (FB) aspiration to the airways is rare in adults. Flexible bronchoscopy (FOB) usually allows for diagnosis. Whether it should be the preferred method for FB extraction is still under debate. Objectives: To review our experience with FOB for the removal of inhaled FB and to evaluate our success rate and complications. Methods: Retrospective analyses of the clinical records of the adult patients with FB aspiration who received FOB for its removal. Results: A total of 95 patients – 34 females (35.8%) and 61 males (64.2%) – were evaluated. The mean age was 66.6 (±14.5). More patients presented with acute aspiration, as defined as aspiration within 1 week. Most procedures were performed in an outpatient basis. The most common FB were seeds (25; 26.3%) and bones (24; 25.3%). The right bronchial tree, particularly the bronchus intermedus and the right lower lobe, was the most affected. FOB allowed complete FB extraction on the first attempt in 79 cases (83.2%). Four (4) patients underwent rigid bronchoscopy (RB), and 11 repeated FOB. Of the last, in only 1 case the FB couldn’t be removed and a RB was performed. Of total, FB was retrieved by FOB in 90 (94.7%) cases. No differences were seen in terms of type of FB, duration between aspiration and the procedure, and final outcome when genders were compared. No statistical differences were seen when comparing acute and chronic aspiration regarding gender, type of FB, and final outcome. Conclusions: Although RB offers a larger working channel and better ventilation control, FOB is a safe and effective procedure for removal of FB from the airways and can be considered the first-line strategy in adult patients.