Bronchoscopic procedures during COVID-19 pandemic: Experiences in Turkey

Abstract

Background: Globally, coronavirus disease-2019 (COVID-19) is a new, highly contagious, and life-threatening virus. We aimed to demonstrate how we proceeded with bronchoscopic procedures without published guidelines at the inception of the pandemic period.

Materials and methods: All bronchoscopic procedures applied from the first case seen in Turkey (11 March-15 May) were evaluated retrospectively. Patient data on indications, diagnosis, types of procedures, and the results of COVID-19 tests were recorded.

Results: This study included 126 patients; 36 required interventional bronchoscopic techniques (28.6%), 74 required endobronchial ultrasonography (EBUS; 58.7%), and 16 required flexible fiberoptic bronchoscopy (12.7%). All interventional rigid bronchoscopic techniques were performed for emergent indications: malignant airway obstruction (66.7%), tracheal stenosis (25%), and bronchopleural fistula (8.3%). Malignancy was diagnosed in 59 (79.7%), 12 (50%), and 4 (25%) patients who underwent EBUS, interventional procedures, and fibreoptic bronchoscopy, respectively. All personnel wore personal protective equipment and patients wore a surgical mask, cap, and disposable gown. Of the patients, 31 (24.6%) were tested for COVID-19 and all the results were negative. COVID-19 was not detected in any of the patients after a 14-day follow-up period.

Conclusion: This study was based on our experiences and demonstrated that EBUS and/or bronchoscopy should not be postponed in patients with known or suspected lung cancer.

Keywords: COVID-19; bronchoscopy; endobronchial ultrasonography; interventional bronchoscopy; lung cancer.

Figure 1

Flow chart of the study

Figure 2

Examples of cases in the study, A‐J. (A and B: pre and postprocedure view of postintubation tracheal stenosis; C and D, pre and postprocedure view of tracheal malign airway obstruction with adenoid cystic carcinoma; E and F, pre and postprocedure view of central (right main bronchus) malign airway obstruction with squamous cell carcinoma; G and H, pre and postprocedure chest X‐ray of left lung complete atelectasis with mucus plaque; I and J, bronchomediastinal fistula, and after covered with metallic stent). K, Protection of health workers and patient's during EBUS‐TBNA L: sonographic view of a sampled subcarinal lymph node. EBUS‐TBNA, endobronchial ultrasonography guided‐transbronchial needle aspiration [Color figure can be viewed at wileyonlinelibrary.com]