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FLEXIBLE BRONCHOSCOPY IN CHILDREN WITH LOW SUSPICION OF FOREIGN BODY ASPIRATION
Kutay Bahadır 1, Denizcan İnal 1, Pari Khalilova 2, Ege Ekiyor 1, Mehmet Erdem Altınörgü 1, Ayşenur Çelik 1, Sümeyye Sözduyar 3, Fatmanur Duruk Erkent 4, Özlem Selvi Can 4, Ufuk Ateş 1, Gülnur Göllü 1, Meltem Bingöl-Koloğlu 1, Murat Çakmak 1, Ergun Ergün 1
1 Ankara University Health Practice and Research Hospital, Department of Pediatric Surgery, Ankara
2 Eskisehir Osmangazi University, Faculty of Medicine, Department of Pediatric Surgery
3 Ege University Medical School, Department of Pediatric Surgery, Division of Pediatric Urology, İzmir, Turkey
4 Ankara University Health Practice and Research Hospital, Department of Anesthesiology and Reanimation
Purpose:
Rigid bronchoscopy (RB) is the gold standard for managing foreign body aspiration (FBA) in children but carries significant risks, including airway complications, foreign body dislocation, bronchospasm, and bleeding. These risks are often unavoidable in high-suspicion cases. In contrast, flexible bronchoscopy (FB) via laryngeal mask ventilation may offer a safer, less invasive option for children with low suspicion of FBA, especially when diagnosis is uncertain. This study aims to evaluate whether FB can help avoid unnecessary RB in such cases.
Methods:
Medical records of children who underwent RB for suspected FBA between 2022–2023 and FB or RB between 2023–2025 were reviewed. Children without witnessed aspiration/choking or unilateral auscultation findings were classified as low-risk; those with these signs as high-risk. Before 2023, both groups underwent RB. After 2023, FB was performed in low-risk patients. If a foreign body was observed, FB was converted to RB. High-risk patients continued to receive RB directly. Foreign body detection rates were compared.
Results:
A total of 207 children were evaluated. Prior to 2023, 106 children underwent RB; no foreign body was found in 50 cases (42%). After 2023, 41 low-risk children underwent FB; 34 (83%) had no foreign body. In 60 high-risk children treated with RB after 2023, the detection rate was 80%.
Conclusion:
FB appears to be a safe and less invasive alternative for children at low risk of FBA. Its use may reduce the number of unnecessary RB procedures. The higher detection rate of foreign bodies in RB after the introduction of FB suggests that FB improves patient selection and overall diagnostic accuracy.