Bronchoscopy and Endobronchial ultrasound (EBUS)
Important information about your bronchoscopy/EBUS procedure.
- Do not eat anything for four hours before your procedure. You may have a drink of clear fluids up to two hours before your procedure. You can take any medicines you need to have with a sip of water up until two hours before your procedure.
- Tell your doctor/nurse about all the medications you take and any medical conditions you have.
- Tell us if you are on any blood thinning or diabetes medications – these are normally stopped before your procedure. It is important that you continue to take other medications (including those for high blood pressure).
- Arrange for someone to bring you in and take you home from the hospital, before and after the bronchoscopy/EBUS. You should also not be alone overnight after your bronchoscopy/EBUS.
- Do not eat or drink after the procedure until the numbness in your mouth/throat has completely worn off, approximately one and a half hours.
- For 24 hours after the bronchoscopy/EBUS you should not drive, return to work, operate machinery, drink alcohol, sign legal documents, be responsible for small children or be left on your own.
- After the bronchoscopy/EBUS, contact your GP, Endoscopy Unit (between 9am - 6pm Monday to Sunday) or attend your local emergency department if you are short of breath, have chest pain or cough up more than a tablespoon of blood in one go.
What is a bronchoscopy?
A bronchoscopy is an examination of the breathing passages (airways) of your lungs. The bronchoscopy is carried out with a thin tube-like instrument with a mini camera at its tip, called a bronchoscope, usually after you have had sedation medicine to make you sleepy.
The bronchoscope allows your doctor to see inside the breathing passages of your lungs. If needed, your doctor can also use the bronchoscope to take samples of mucus or tissue (biopsies) from inside your lungs. It can also be used for removing an inhaled foreign body (such as a peanut or tooth filling).
What is an endobronchial ultrasound (EBUS)?
An endobronchial ultrasound (EBUS) is similar to a bronchoscopy where the bronchoscope also has an ultrasound probe on the end of it. This allows your doctor to see structures just outside of your breathing passages of your lungs and take samples of lymph nodes within the chest. These samples can be then sent to the laboratory and checked for any abnormalities.
Why do I need a bronchoscopy/EBUS?
Your doctor has recommended a bronchoscopy/EBUS to help make a diagnosis for your current symptoms and to help make treatment decisions for you. They feel the benefits to you outweigh the small risks of the procedure.
The decision is made carefully with your best interests in mind. It is your decision whether you wish to have the procedure.
Your doctor will have explained why you need the bronchoscopy/EBUS. Some of the common reasons why a bronchoscopy/EBUS is required include:
- Infection: samples collected from your lungs can help your doctor to find the causes of infection and give you appropriate treatment. Your doctor can also use the bronchoscopy/EBUS to clear some of the mucus from your breathing passages.
- Bleeding: if you are coughing up blood, your doctor can look inside your breathing passages to find out where blood may be coming from.
- Abnormal chest X-ray or CT scan: there may be a narrowing of one of your breathing passages or an abnormality in your lung, which your doctor wants to investigate to find the cause.
- Persistent cough: Samples taken during a bronchoscopy/EBUS and an examination of the breathing passages can sometimes help to determine the cause for a cough that does not respond to medication.
- Noisy breathing: A bronchoscopy/EBUS can help to see if narrowing of your breathing passages or erratic movement of your vocal cords (voice box) is causing additional breathing sounds.
Is there an alternative test that I can have instead of bronchoscopy/EBUS?
Your doctor can carry out breathing tests, x-rays and CT scans of your lungs. These tests will give additional information about your lungs.
However, a bronchoscopy/EBUS gives very specific information to your doctor by allowing them to look inside your breathing passages and collect samples. There is usually no alternative way of doing this.
How should I prepare for my bronchoscopy/EBUS?
Please attend the appointment date and time you have received in your appointment letter. If you need to cancel please let us know as soon as possible and we will reschedule your procedure and make use of the appointment for another patient.
Please let us know if you may be pregnant, as we may need to cancel or postpone your procedure.
Fasting instructions
Do not eat anything for four hours before the procedure. You may have a drink of clear fluids up to two hours before your procedure. You can take any medicines you need to have with a sip of water up until two hours before your procedure. Please make sure that you follow these fasting (starving) instructions. Fasting is very important before a procedure with sedation. If you have anything in your stomach whilst you are under sedation it might come back up and get into your lungs. Your procedure will be cancelled if these instructions are not followed.
It is also better not to smoke before the procedure, because this can reduced how much oxygen your blood can carry.
On the day of your bronchoscopy/EBUS, before your procedure we will need details of all your medications (including any over the counter remedies), allergies, and any other medical conditions.
It is important to let us know in advance if you take blood thinning or diabetes medications as we will need you to temporarily stop taking these before your procedure. You should take all your other medications as usual on the morning of the procedure – these should be taken with a sip of water at least two hours before you arrive.
If you take medication for high blood pressure or for your heart, it is particularly important that you continue taking your tablets or any inhalers you are prescribed.
The following section explains what to do with your medications. Please contact us if you are not sure what to do.
Diabetes medications
- Diabetes tablets (e.g. Glibenclamide, Gliclazide, Glimepiride, Glipizide, Tolbutamide, Metformin, Pioglitazone and Sitagliptin) - do not take on the morning of the procedure.
- Dapagliflozin (Forxiga), Canagliflozin (Invokana), Empagliflozin (Jardiance), Ertugliflozin (Steglatro) - usually stopped one full day before your procedure.
- Insulin injections - the dose of your insulin will usually need to be either reduced or stopped on the morning of your procedure. If in doubt, please don't take your insulin but bring it with you, along with your other medicines, or contact your diabetic specialist nurse for advice.
Blood thinning medication
- Warfarin - usually stopped five full days before the procedure. You will need an INR blood test one to two days before your procedure to make sure your INR is below 1.5. If you do not have this test, we will need to cancel your procedure.
- IF you take warfarin due to having metal heart valves, please seek advice from the respiratory team on the telephone numbers in this leaflet (page 14). Do not stop your warfarin until advised to do so.
- Aspirin - do not take on morning of procedure.
- Clopidogrel (Plavix), Dipyridamole (Persantin) and Ticagrelor (Brilique) - usually stopped seven full days before the procedure.
- Apixiban (Eliquis), Dabigatrans (Pradaxa), Rivaroxaban (Xarelto), and Edoxaban (Liliana) - usually stopped two full days before the procedure.
- Enoxaparin (Clexane) injections - usually stopped one full day before the procedure.
All other medications
- Take as normal, at least two hour hours before the procedure with a sip of water.
- Please bring all of your medications with you when you come for the procedure. You should also bring any glasses you need for reading. Please do not wear jewellery of nail varnish or bring in any valuables.
What will happen on the day?
Please come to the reception desk in the Endoscopy Unit at the time you have been given. You should expect to be in the hospital for approximately four hours.
When you arrive, a nurse will greet you and take your blood pressure, heart rate and temperature. They will also ask you questions about your medical history, medications and any allergies you might have.
The procedure will be explained to you again and you will have the opportunity to ask any questions you might have. If you have not done so already you will be asked to sign a consent form to confirm you are happy for the procedure to go ahead.
The nurse or doctor will insert a cannula (tiny plastic tube) into your hand or arm. This will be used to give you the sedation medication into your vein, to make you more relaxed during the procedure.
When your bronchoscopy/EBUS is due to start, you will be shown into the procedure room and will be asked to lie on a hospital trolley. Your blood pressure, oxygen levels and heart rate will be monitored using a cuff on your arm and a sensor on your finger. You will be given some oxygen into your nose or mouth to keep the oxygen in your blood at a safe level.
Your nose and throat will be numbed with local anaesthetic gel and/or spray. This can make your eyes water briefly and tastes rather bitter. The numbness will make you feel as if you can’t swallow, but you will still be able to. We will then give you the sedation medication into the cannula to make you feel relaxed.
When you are ready, your doctor will insert the bronchoscope/EBUS into one of your nostrils or through a “guard” in your mouth (designed to protect the bronchoscope/EBUS).
The bronchoscope/EBUS will go down the back of your throat and into your breathing passages. Further local anaesthetic will be used to numb your voice box and breathing passages. This may make you cough, but will not be painful.
The doctor will examine your breathing passages and may take samples. Before the procedure, the doctor will have discussed with you the samples that are likely to be taken and how they are collected. This may include:
- Washing: Saline (salty water) flushed through the bronchoscope, into the lung and sucked out again, to collect cells for analysis.
- Brushings: A brush, which can be passed down the bronchoscope to brush cells from the lining of the air tubes in the lungs.
- Biopsies: A pair of forceps which can be passed down the bronchoscope and used to take small tissue samples.
- EBUS: A needle, which can be passed down the bronchoscope to take a sample from enlarged lymph nodes.
Are there any risks?
Bronchoscopy/EBUS is a generally safe procedure. Serious complications are rare.
Common complications:
- Many people find that they cough during the procedure.
- Oxygen levels can drop during the procedure. This is carefully monitored and supplemental oxygen is given.
- A small number of people get a sore throat or hoarse voice after the procedure. If this does not settle within 48 hours, you should contact your GP.
- A small amount of bleeding from the lung or airway occurs whenever a biopsy (sample) is taken, so you can expect to have some blood staining of your phlegm after the procedure.
Rare complications:
- Approximately one in three people develop a fever six to twelve hours after the bronchoscopy/EBUS. This goes away by itself and is not usually a sign of an infection. If needed, you can take some paracetamol. If you have an ongoing fever for longer than twelve hours, please let your GP know, so that they can test you for an infection.
- A small number of people may have a nosebleed, but this is usually minor.
- Occasionally, some people take a longer time to recover after the procedure and may need to be admitted to hospital for observation.
- Some people are unable to tolerate the procedure at all and the test is abandoned. This may mean a repeat test is needed in the future.
Very rare complications:
- Rarely, bronchoscopy/EBUS can cause a puncture (hole) in the lung wall. This can cause breathlessness and a sharp pain in the chest. It is extremely rare, unless a type of biopsy called a transbronchial biopsy is carried out, in which case it occurs in about 1 in 10 people. If you need a transbronchial biopsy, the risks will be explained before we ask you to sign the consent form, and a chest x-ray would be performed after the procedure. If a puncture does occur, 9 times out of 10 it heals itself without further treatment. In the rare case when a puncture requires treatment, a small tube is passed between the ribs under local anaesthetic to remove the air leaking from the lung.
- Occasionally more significant bleeding can occur, but this is uncommon. This may require specific treatment, and very rarely may need to be treated with a blood transfusion.
- Arrhythmia (your heart beating abnormally).
- Occasionally, during EBUS procedures only, there is a risk of the needle used for sampling your lymph nodes breaking (less than 1 in 100 people).
- Death from bronchoscopy has been recorded as occurring in around 1 in 10,000 procedures carried out. However, the people who have died from bronchoscopy were almost always very unwell beforehand.
Will it be unpleasant?
The sedative used during the procedure usually means you have no unpleasant memory of what took place. The procedure is likely to cause you to cough, but this shouldn’t be painful.
What happens after the bronchoscopy/EBUS?
The bronchoscopy usually lasts between 20 to 40 minutes. If you are having an EBUS, the procedure usually lasts 45-90 minutes.
Afterwards you will be sleepy. You will be monitored by a nurse in our recovery area until you are awake enough to leave. You may have a chest x-ray if the doctors want to make sure you haven’t had a puncture in your lung wall. You should not eat or drink until the feeling in the back of your throat has returned. This should take about one and a half hours (ninety minutes).
As the sedation medicine can affect your judgement and behaviour slightly (even if you think you are feeling fine) you should not drive, work, operate machinery, drink alcohol, sign any legal documents, or be responsible for small children for 24 hours after the procedure.
You will not be able to drive for 24 hours after the bronchoscopy/EBUS (this is a legal requirement after sedation) and it is not safe for you to ride home on a bus. It is essential that someone accompanies you home, either driving you home or travelling with you in a taxi. You should not go home on public transport after this procedure. You will need to be taken home by car. This will be more comfortable for you and also quicker for you to return to the hospital if there are any complications on the journey home. You should not be alone for 24 hours after your bronchoscopy/EBUS, in case you feel unwell.
Getting the results
The results of your bronchoscopy/EBUS will not be available immediately. It takes several days to weeks for the specimens to be analysed. You should receive your results on your next clinic attendance or by letter.
How to contact us
If you have any questions please contact:
- Furness General Hospital Endoscopy Unit telephone: 01229 491112
- Royal Lancaster Infirmary Endoscopy Unit telephone: 01524 551349 or 01524 591573
If the endoscopy team cannot help you, you can also contact us via the respiratory secretaries during working hours on the numbers below:
- Furness General Hospital telephone: 01229 403736 or 01229 403723
- Royal Lancaster Infirmary telephone: 01524 511979 or 01524 519361
Date of Publication: 14/02/2024
Reference code: lc00013627/PIL221
Date of next review: 01/02/2027