Removal of foreign bodies by rigid bronchoscopy technique in children - The end of an era?

BACKGROUND/HYPOTHESIS: Recommendations regarding management of foreign body (FB) aspiration in childhood have not substantially been modified since 1897 when Gustav Kilian first described the technique how to extract FBs by rigid bronchoscopy. Many paediatric pulmonology centers have adapted a two-step-procedure: First, to explore the airways by flexible bronchoscopy in case of suspicion of a FB aspiration, and then, if confirmed, to switch to rigid bronchoscopy for FB removal. In recent years, instruments have been developed especially for FB removal by flexible bronchoscopy. We hypothesize that it is no longer necessary to routinely pursue the two-step procedure. CASE: We present the case of a 2-year-old boy who aspirated a peanut. In order to exemplarily share our experiences regarding the modern technique, we display serial photographs from the video taken during the procedure of FB removal by specialized instruments for flexible bronchoscopy. In our center, this flexible technique has developed into the usual method of choice; only in rare cases it is necessary to switch to a rigid bronchoscopy procedure. DISCUSSION: There are only few reports on the novel flexible method for FB removal in children. A safe one-step procedure with flexible bronchoscopy offering both a diagnostic and a therapeutic potential appears to be an advantageous method for the management of our young patients. We suggest to compile and analyze paediatric pulmonologists9 experiences with the new technique, in order to finally formulate recommendations for the most advisable first-line procedure of bronchial FB removal in children.