Bronchoscopy and airway procedures

Which procedure has been recommended to you?

The three procedures answer different questions, and knowing which one you are booked for tells you a lot about what your team is trying to establish.

• Flexible bronchoscopy is for looking at the airways and sampling the lung itself. Sedation, day case. Read bronchoscopy.
• EBUS-TBNA is for lymph nodes in the centre of the chest, most often to stage a lung cancer or to find out whether enlarged nodes are tuberculosis, sarcoidosis or something else. Read EBUS-TBNA.
• Rigid bronchoscopy is for treating a large airway rather than investigating it, under general anaesthesia. Read rigid bronchoscopy.

These are frequently combined. An EBUS is performed with a flexible scope in the same sitting, and a flexible scope is often passed through a rigid one to reach further into the smaller airways.

Procedures covered elsewhere

The interventional pulmonology service page covers the wider range of airway and pleural work, including balloon dilatation, cryotherapy, electrocautery and laser, airway stenting, medical thoracoscopy and pleural procedures. Post-transplant airway management is described in airway complications after lung transplant.

Before you consent to any of them

Three questions are worth asking, and a good team will answer all of them without hesitation. What specific question is this procedure meant to answer? What happens if the result comes back negative or inconclusive, does the investigation stop there or does another step follow? And is there a less invasive test that would answer the same question?

If you have been advised to have a surgical lung biopsy, it is particularly worth asking whether a cryobiopsy would give the same answer, since it avoids general anaesthesia and a chest drain for many patients. A second opinion before an invasive procedure can be issued from your existing scans and reports without an in-person visit.

Where these are performed

All three are performed by Dr. Manjunath M Negigoudara at KIMS Hospital, Electronic City, Bengaluru, where thoracic surgery and ECMO are available on site. He holds a Fellowship in Interventional Pulmonology from Manipal Hospitals alongside MD in Pulmonary Medicine and DNB in Respiratory Medicine. Call or WhatsApp +91 79937 41199, Monday to Saturday, 9 AM to 5 PM.

How do I prepare for an airway procedure?

Preparation is broadly the same for all three, and getting it right avoids the two commonest reasons a procedure is cancelled on the day.

• Fasting. Nothing to eat for six hours beforehand, nothing to drink for two, because sedation or anaesthesia is used.
• Blood thinners. Decided individually and never stopped on your own. Aspirin can usually be continued; clopidogrel, warfarin and the newer oral anticoagulants normally need stopping for a defined period. Tell the team about any heart stents or mechanical valves.
• Bring the imaging itself. The CT or PET files, not just the report. The operator plans which segment or which node to sample from them.
• Tell the team about diabetes and your insulin schedule, asthma or COPD, home oxygen use, allergies to anaesthetics, and any previous difficulty with sedation.
• Arrange an escort. After sedation it is unsafe to drive or travel alone for 24 hours.

What do these procedures cost in Bangalore?

Cost depends on whether the procedure is purely diagnostic or includes biopsies, ultrasound guidance, therapeutic work or a stent, on whether rapid on-site cytology is used, and on which laboratory tests the samples are sent for. A bronchoscopy with washings and a rigid bronchoscopy with tumour debulking and a stent are different procedures with very different costs.

KIMS Hospital, Electronic City is empanelled with all major Indian health insurers and offers corporate cashless facility for most third-party administrators. Bring your policy or corporate health card and the insurance desk handles pre-authorisation. For a specific estimate for your case, call +91 79937 41199.

Who performs these procedures?

Dr. Manjunath M Negigoudara is a Transplant Pulmonologist at KIMS Hospital, Electronic City, Bengaluru, with a Fellowship in Interventional Pulmonology from Manipal Hospitals alongside MBBS as a Gold Medalist from Bangalore Medical College, MD in Pulmonary Medicine from JSS Medical College and DNB in Respiratory Medicine. Karnataka Medical Council registration 116911.

Airway procedures are operator-dependent in a way that is easy to underestimate. The decision that most affects the result is made before the scope is picked up: which technique will answer this question in this patient, and which segment or which node to sample. A lavage from the wrong lobe, or forceps where a cryobiopsy was needed, produces a non-diagnostic result and the patient goes through the whole thing again.

Because Dr. Manjunath also runs the transplant service, diagnostic bronchoscopy, therapeutic airway work and the post-transplant airway sit in one department rather than three. He has personally managed 250+ lung transplant cases within the KIMS Institute of Heart and Lung Transplant, which has completed 780+ thoracic transplants. See the full clinical profile.

For patients from Bangalore, across India, and abroad

Bengaluru and Electronic City

KIMS Hospital is on Hosur Road at Konappana Agrahara, about 15 minutes from Silk Board on the elevated expressway and served by the Yellow Line metro. Day-case patients attend from HSR Layout, Koramangala, Sarjapur Road, BTM Layout, Jayanagar, JP Nagar and Bannerghatta Road, and from Bommasandra, Anekal and along the Hosur Road corridor. Remember that you need someone to take you home.

Karnataka and the rest of India

Because few centres offer the full therapeutic range, patients are referred from Mysuru, Mangaluru, Hubballi-Dharwad, Belagavi, Kalaburagi, Shivamogga, Tumakuru, Davangere and Ballari, and from Hosur, Krishnagiri, Chennai, Coimbatore, Madurai, Salem, Hyderabad, Warangal, Vijayawada, Visakhapatnam, Kochi, Thiruvananthapuram, Goa, Mumbai, Pune, Nagpur, Ahmedabad, Delhi NCR, Kolkata, Bhubaneswar, Guwahati, Lucknow, Patna and Raipur. Send the CT images on WhatsApp beforehand so consultation and procedure can be scheduled on consecutive days rather than requiring two trips. Kempegowda International Airport is about 45 km away.

International patients

Patients are seen from Bangladesh, Nepal, Sri Lanka, the Maldives and Bhutan, from Oman, the UAE, Saudi Arabia, Iraq, Kuwait, Bahrain and Qatar, from Kenya, Tanzania, Ethiopia, Uganda, Nigeria and Ghana, and from Myanmar, Indonesia and Malaysia. Imaging is reviewed over WhatsApp first, a written opinion can support a medical visa application, and diagnostic work is usually compressed into a three to four day visit.