Interventional Bronchoscopy for Tuberculosis Management

Interventional bronchoscopy has emerged as a pivotal tool in the management of tuberculous airway disease, combining advanced imaging, diagnostic sampling and therapeutic modalities into a cohesive endoscopic approach. Central to this field is the treatment of tracheobronchial complications that arise despite effective chemotherapy, notably cicatricial stenosis, tracheobronchomalacia and bronchial occlusion. Fibre-optic and rigid bronchoscopes allow for direct visualisation of the tracheobronchial tree, while novel modalities such as endobronchial optical coherence tomography permit in vivo microstructural assessment of bronchial cartilage. Diagnostic bronchoscopic techniques, including targeted biopsies, cytological brushing and bronchoalveolar lavage, have been augmented by molecular assays, enabling rapid detection of Mycobacterium tuberculosis and rifampicin resistance. Therapeutic interventions range from mechanical dilatation—using balloon catheters or rigid instruments—to adjunctive measures such as topical mitomycin-C, cryotherapy, laser ablation and airway stenting. These procedures aim to restore luminal patency, mitigate fibrotic scarring and reduce progression to severe airway obstruction. The integration of interventional bronchoscopy into tuberculosis care pathways has shown promise in shortening symptom duration, reducing the need for surgical reconstruction and improving long-term pulmonary function. Globally, these techniques are being refined in high-burden settings, addressing challenges of resource variability and shaping guidelines that bridge chemotherapy and interventional strategies. Future directions include standardisation of procedural indications, optimisation of device selection and evaluation of host-directed therapies delivered endoscopically to limit inflammation and fibrosis.

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Interventional Bronchoscopy for Tuberculosis Management publication trend

The graph below shows the total number of articles in interventional bronchoscopy for tuberculosis management across all publications each year (not limited to Nature Index journals).

Technical terms

Endobronchial optical coherence tomography: A high-resolution imaging modality that uses near-infrared light to visualise microstructural details of the airway wall and cartilage in vivo.

Balloon dilatation: A mechanical intervention in which an inflatable catheter applies radial force to stenotic airway segments to widen the lumen.

Topical mitomycin-C: An antifibrotic agent applied directly to the bronchial mucosa after dilatation to inhibit scar tissue formation.

Rigid bronchoscopy: An endoscopic technique employing a straight, hollow metal tube for airway examination and intervention, offering greater mechanical stability and larger working channels than fibre-optic bronchoscopy.

Bronchoalveolar lavage: A diagnostic procedure involving the instillation and retrieval of saline in a distal airway segment to collect cells and microorganisms for laboratory analysis.

References

1. Treatment of multiple-level tracheobronchial stenosis secondary to endobronchial tuberculosis using bronchoscopic balloon dilatation with topical mitomycin-C. BMC Pulmonary Medicine (2016).
2. Early and Regular Bronchoscopy Examination on Effect of Diagnosis and Prognosis for Patients With Tracheobronchial Tuberculosis. Frontiers in Medicine (2022).
3. Endobronchial optical coherence tomography helps to estimate the cartilage damage of the central airway in TBTB patients. Frontiers in Cellular and Infection Microbiology (2023).
4. Diagnostic Efficacy of Xpert MTB/RIF Assay in Bronchoalveolar Lavage Fluid for Tracheobronchial Tuberculosis: A Retrospective Analysis. Frontiers in Medicine (2021).