The Use of Flexible Bronchoscope for Diagnostic Medical Thoracoscopy in a Resource-Limited Setting: A Retrospective Study.

Background: Exudative pleural effusion (ePE) is a common presentation in pulmonology clinics. Pleural biopsy is indicated for identifying the etiology in undiagnosed ePE, especially those with low adenosine deaminase levels. Access to rigid and semi-rigid medical thoracoscopy is scarce and heterogeneous in a resource-limited country like India. In such circumstances, using a flexible bronchoscope via an intercostal chest tube for visualization of the parietal pleura and pleural biopsy offers a way out. Materials and Methods: In this retrospective study, we have presented our experience of such practice on 25 cases. Mean age was 52.4±1 years. Adhesions were present in 40% of the subjects. Results: The most common finding was the presence of nodules. On average, 6.8 passes were taken with a maximum of 10. In 32% cases, only tiny tissue was obtained, hence requiring multiple passes. Large tissue could be obtained in 44% of the subjects. The mean duration of the procedure was 35.6±9.0 minutes. Tissue diagnosis was established in 80% with the most common being malignancy (48%), followed by tuberculosis (20%). In 3 cases, the final diagnosis was made by exclusion. No major complications were recorded. Conclusions: In conclusion, medical thoracoscopy using a flexible video bronchoscope via intercostal chest tube was a feasible alternative for the diagnosis of ePE effusion in resource-limited settings.