From rigid to flexible bronchoscopy: A tertiary center experience in removal of inhaled foreign bodies in children

Background: rigid bronchoscopy is the procedure of choice for removal of inhaled foreign bodies and has a certain complication rate.

Aim: to assess whether flexible bronchoscopy is an efficient and safe procedure in removal of inhaled foreign bodies in children, compared to rigid bronchoscopy. To further assess if it is associated with a shorter procedure time, and shorter length of stay in the hospital (LOS).

Methods: a retrospective study including patients aged 0-18 years which were hospitalized in Soroka University Medical Center (SUMC) throughout 2009-2019, and underwent flexible or rigid bronchoscopy for the removal of an inhaled foreign body. The data were analyzed according to two time periods; 2009-2016 and 2017-2019.

Results: from 2009-2019, 182 patients (median age of 24 months, 58% males) underwent an interventional bronchoscopy; 40 (22%) by flexible and 142 (78%) by rigid bronchoscopy. 88.7% of rigid and 95% of flexible bronchoscopies were successful in the removal of foreign bodies (p value=0.24). Complications rate was higher among rigid bronchoscopy (9.2 % vs. 0%, p =0.047). From 2017 onwards, after implementation of the flexible bronchoscopy for removal of foreign bodies, 64 procedures were performed; 33 (51.6%) flexible and 31 (48.4%) rigid. Procedure length was shorter via flexible bronchoscope (42 vs 58 minutes, p = 0.016). No significant difference was found in LOS.

Conclusion: Flexible bronchoscopy is an efficient and safe method for removal of inhaled foreign bodies in children, with shorter procedure time and minimal complication rate. Flexible bronchoscopy could be considered as the procedure of choice for removal of inhaled foreign bodies in children, by an experienced multidisciplinary team.