Comparison of diagnostic yield and complication of medical thoracoscopy using Flexible Bronchoscope versus Semi-Rigid Pleuroscope among Hospitalized Patients with Pleural Effusion (FLEXPLEUR): a retrospective observational study.

Background: Pleural effusion is a prevalent issue worldwide presenting with a diagnostic challenge. Medical thoracoscopy (MT) via a semi-rigid pleuroscope (SRP) or rigid thoracoscope is the gold standard for diagnosing the aetiology of pleural effusions when less invasive tests fail. MT using a flexible bronchoscope (FB) could offer a viable alternative. However, there is a lack of comparative studies between MT using a SRP and a FB. We aimed to compare the diagnostic yield and complications of MT using a FB versus a SRP in the Respiratory Unit, Hospital Canselor Tuanku Muhriz, National University of Malaysia. Methods: Comparative, retrospective and observational study that reviews the hospital database of patients who underwent MT with either FB or SRP between January 2011 and May 2024. Results: A total of 178 patients were recruited (FB: n=90, SRP: n=88). There was no significant difference in diagnostic yield between FB (91.1%) and SRP (87.5%) (P=0.44). There was no significant difference in complications during the procedure between FB (8.9%) and SRP (4.5%) (P=0.25). However, a higher rate of post-procedure complications with a FB (12.2%) compared to a SRP (1.1%) (P=0.003) was observed. The mean overall complication rate is higher for FB (0.20±0.429) than for SRP (0.06±0.233) (P=0.006). Conclusions: MT using a FB could be a viable alternative for diagnosing pleural diseases in settings with limited resources, especially when conventional methods have failed.