Background: Foreign body aspiration (FBA) in the tracheobronchial tree
is a common problem in the pediatric population. Rigid bronchoscopic
procedure is currently the gold standard method for treatment in
pediatric patients, whereas recent reports present flexible bronchoscopy
as an alternative method. The aim of this study was to summarize all
available evidence regarding the application and the success rate of
flexible bronchoscopy in foreign body (FB) removal. Methods: Systematic
review of the use of flexible bronchoscopy as the first-line treatment
in FBA cases in PubMed from 2001 to 2021. Results: Out of 243 citations,
23 studies were included on the use of flexible bronchoscopic procedure
as a treatment of choice in 2,587 children with FBA. The FBs were
successfully removed in 2,254/2,587 (87.1%) patients with a low
complication rate. The majority of FBs retrieved were organic materials
1,073/1,370 (78.3%), and they were most commonly lodged in the right
bronchial tree 708/1,401 (50.5%). General anesthesia was applied in
most studies (14/23) before proceeding to a flexible bronchoscopy and
laryngeal mask airways (LMAs) were mostly used (10/23 studies) to secure
the airway during the procedure. Ancillary equipment, usually forceps
1,544/1808 (85.4%) assisted in the FB retrieval. Conclusion: The use of
flexible bronchoscopy is shown to be a feasible and safe alternative
therapeutic procedure in FBA cases. There is a need for development of
extraction equipment and techniques to assist the procedure. Finally,
future studies focusing on the comparison between clinical outcomes of
flexible and rigid bronchoscopies are necessary.
A systematic review of the current management of oroesophageal fishbones foreign body