Medicine Institute, Cleveland Clinic, Cleveland, OH.
Respiratory Institute, Cleveland Clinic, Cleveland, OH.
Chest. 2019 Apr;155(4):834-847. doi: 10.1016/j.chest.2018.08.1035. Epub 2018 Aug 29.
Advanced technologies such as endobronchial ultrasound and electromagnetic navigation have revolutionized the field of bronchoscopy. Its indications as a diagnostic as well as a therapeutic tool continue to expand at a rapid pace. This growth also has led to the emergence of a new subspecialty of interventional pulmonology and more than 40 fellowship training programs. However, with increasing popularity and accessibility, there is a high impetus for performing the procedure when it may be of limited value. On the basis of a literature review and our own experience, we produced a list of conditions for which bronchoscopy is of limited value yet is being performed frequently. Conditions such as idiopathic pulmonary fibrosis, massive hemoptysis, cystic fibrosis, smear-negative pulmonary TB, and stage I sarcoidosis may be approached best in a more prudent fashion, with the bronchoscopic approach reserved for exceptional cases. We present an overview of conditions for which the expectations for bronchoscopy exceed the evidence in the literature, and we coined the term "forbearance with bronchoscopy" for situations in which this popular tool may not be the most appropriate initial approach.
先进的技术，如支气管内超声和电磁导航，彻底改变了支气管镜检查领域。它作为一种诊断和治疗工具的适应证正在迅速扩大。这种增长也导致了介入肺病学的一个新亚专科的出现，以及 40 多个奖学金培训项目。然而，随着普及性和可及性的提高，在支气管镜检查可能价值有限的情况下，进行该检查的动力也很高。基于文献回顾和我们自己的经验，我们列出了一些支气管镜检查价值有限但却经常进行的情况。例如特发性肺纤维化、大咯血、囊性纤维化、涂片阴性肺结核和 I 期结节病等疾病，最好以更谨慎的方式进行治疗，将支气管镜检查保留给特殊情况。我们介绍了一些情况下，支气管镜检查的预期效果超过了文献中的证据，我们创造了“支气管镜检查的克制”这个术语，用于描述在这种流行的工具可能不是最合适的初始方法的情况下。
