World-renown for our expertise in bronchoscopy, Cleveland Clinic’s Advanced Diagnostic and Interventional Bronchoscopy Program leads the way in developing new diagnostic and therapeutic bronchoscopy techniques. We are pioneers in therapeutic techniques, such as electromagnetic navigation, self-expanding metallic stents and metallic stent removal. In fact, our pulmonologists were the first in the North America to perform navigational bronchoscopy.
Treating Patients with Complex Conditions
Our highly-skilled physicians have extensive experience in treating airway disease related to lung transplantation, benign and malignant airway diseases, and complications of tracheostomy. As part of the Cleveland Clinic Respiratory Institute, consistently ranked one of the nation’s top pulmonology programs, our program handles the most complex cases, even those considered “unsolvable” by other institutions.
Our approach to patient care is simple—any abnormality in the chest is urgent. We provide rapid access to the safest, most accurate procedures. Often, we may diagnose, perform cancer staging, treat and relieve a patient’s symptoms in one procedure. With onsite cytopathology, many patients know their diagnosis immediately after the procedure.
Center for Major Airway Diseases
The Center for Major Airway Disease comprises a group of dedicated caregivers who coordinate care for patients with benign and malignant complex airway disease. This multidisciplinary team includes otolaryngologists (ENT), anesthesiologists, pulmonologists, thoracic surgeons, nurses and other staff.
Using a collaborative model of care, we co-manage patients with airway complications from lung transplantation, tracheostomy (tracheal tubes), lung and metastatic cancers, inflammatory airway diseases, and benign airway diseases. Whether a patient needs surgery or endoscopic management, we ensure the patient is evaluated by the physician best-suited to care for their condition.
In 2010, Cleveland Clinic Respiratory Institute opened the most technologically advanced bronchoscopy suite in the world. The Patricia L. and Thomas P. Brundige Bronchoscopy Suite is designed to provide an ideal environment for patient care and to accommodate our increasing diagnostic and therapeutic bronchoscopy volumes. The suite includes three rooms fully equipped for all types of advanced diagnostic and therapeutic procedures, integration with radiology PACS, rapid on-site cytopathology work station, and ultrasound-guided thoracentesis service. It is staffed by nurses, technicians, respiratory therapists and dedicated anesthesia teams.
Cleveland Clinic pulmonologists offer the following diagnostic and therapeutic procedures.
Advanced Diagnostic Bronchoscopy
- Electromagnetic navigation diagnostic bronchoscopy (ENB)
- Mediastinal endobronchial ultrasound
- Narrow-band imaging bronchoscopy (NBI)
- Peripheral endobronchial ultrasound
Therapeutic Bronchoscopy & Interventional Pulmonology
- Argon plasma coagulation in tumor ablation and cauterization
- Balloon dilation for airway narrowing
- Brachytherapy (high-dose rate) for tumor destruction
- Broncholith removal of lesions obstructing the airway due to histoplasmosis
- Cryotherapy for bronchial lesions
- Endobronchial electrosurgery for removal and destruction of airway lesions
- Endobronchial mitomycin-C to delay airway restenosis
- Endobronchial steroid injection for inflammatory diseases (e.g., Wegener’sGranulomatosis)
- Foreign body removal
- Heimlich valve insertion for pneumothoraxes
- Intralesional cidofovir injection as an adjunctive treatment of HPV
- YAP laser photoresection for malignant central airway obstruction
- Rigid bronchoscopy
- Stent removal/revision
- Stent placement for airway narrowing (e.g., AeroStent Technology System (STS)™, Ultraflex™, Dumon®, Polyflex® and Y-stent)
- Transtracheal oxygen catheter placement (TTO2) for severe hypoxia
- Pleurex® catheter insertion for malignant pleural effusions
- Ultrasound-guided biopsy and thoracentesis for pleural effusions
A bronchoscopy is an examination of the air passages leading to your lungs. It involves passing a flexible tube called a bronchoscope through the nose or mouth, past the vocal chords and into the airway. A small camera conveys the images to a television monitor. Useful in the diagnosis and treatment of pulmonary disorders, the procedure involves little risk and is not painful.
Bronchoscopy is the gold standard test for seeing inside the airway. The test can be performed to:
- diagnose lung diseases
- locate the source of a problem by visualizing the throat, larynx, trachea and lungs
- collect tissue samples for biopsies
Bronchoscopy has many therapeutic uses, such as:
- removing objects or mucus blocking the airway
- destroying growths in the airway
- placing stents to open airway obstructions
- aid in allergy treatments
Our Advanced Diagnostic and Interventional Bronchoscopy Program is one of the largest of its kind in the country with four full-time interventional pulmonologists. Our physicians serve on the Lung Transplantation Team and collaborate with staff at Cleveland Clinic Chest Cancer Center and Center for Major Airway Disease.
The following Cleveland Clinic Respiratory Institute doctors specialize in performing advanced bronchoscopy and interventional pulmonology procedures:
- Thomas Gildea, MD, MS, Medical Director, Section of Bronchoscopy
- Michael Machuzak, MD, Medical Director, Center for Major Airway Disease
- Francisco Almeida, MD, MS
- Joseph Cicenia, MD
Make an Appointment
Call 216.444.6503 or toll-free 800.223.2273, ext. 46503, or contact us online to make an appointment today.
Cleveland Clinic Respiratory Institute doctors have been and continue to be at the forefront of nearly every major advancement in the field of bronchology.
Some of our major research highlights include:
- restoring voices from tracheotomy complications
- performing the first electromagnetic bronchoscopy in North America
- holding the patent on the Hoffman backward grabbing forceps, invented to solve problems associated with the need to reach behind a stent or lesion
- pioneering airway stenting to treat airway dehiscence in lung transplant patients
Bronchoscopy Research & Clinical Trials
- » Study of the AeriSeal® System for HyPerInflation Reduction in Emphysema (ASPIRE)
Demonstrate the safety and efficacy of AeriSeal System treatment plus optimal medical therapy compared to optimal medical therapy alone in patients with advanced upper lobe predominant (ULP) heterogeneous emphysema. For more information, please contact Yvonne Meli, RN at 216.445.4215
- » PneumRx RePneu Lung Volume Reduction Coil (RePneu LVRC) Trial for Treatment of Emphysema
The objective of this study is to demonstrate the safety and effectiveness of the PneumRx RePneu Lung Volume Reduction Coil (RePneu LVRC) System in a population of patients with emphysema. For more information, please contact Yvonne Meli, RN at 216.445.4215
- » Lung Function Improvement after Bronchoscopic Lung Volume Reduction with Pulmonx Endobronchial Valves used in Treatment of Emphysema (LIBERATE STUDY)
The purpose of this study is to assess the safety and effectiveness of bronchoscopic lung volume reduction (BLVR) using the Pulmonx Endobronchial Valve (EBV) to decrease volume in targeted regions of the lung. For more information, please contact Yvonne Meli, RN at 216.445.4215
- » AQuIRE—The ACCP Quality Improvement Registry
Cleveland Clinic is one of a small number of centers in the United States to actively participate in the ACCP Quality Improvement Registry, Evaluation and Education (AQuIRE). We submit patient data outcomes to the web-based registry with the goal of creating benchmarks for bronchoscopic procedures. Sponsored by the American College of Chest Physicians (ACCP), the registry aims to improve our understanding of how best to optimize our resources, provide evidence of performance, measure complications, and further research, publication and quality improvement.
Recommended Research Readings
Below is a list of recent peer-reviewed research articles written by Cleveland Clinic doctors and staff.
- Anastomotic Airway Complications After Lung Transplantation
Murthy SC, Gildea TR, Machuzak MS. Curr Opin Organ Transplant. 2010 Oct: 15(5):582-7. Review.
- High Dose-rate Endobronchial Radiotherapy for Proximal Airway Obstruction Due to Lung Cancer: 8-year Experience of a Referral Center
Manali ED, Stathopoulos GT, Gildea TR, Fleming P, Thornton J, Xu M, Papiris SA, Mehta AC, Mughal MM. Cancer Biother Radiopharm. 2010 Apr: 25(2):207-13.
- Anesthesia and Airway Management for Removing Pulmonary Self-expanding Metallic Stents
Doyle DJ, Abdelmalak B, Machuzak M, Gildea TR. J Clin Anesth. 2009 Nov: 21(7):529-32. Review.
- Safety of Diagnostic Bronchoscopy in Patients with Pulmonary Hypertension
Diaz-Guzman E, Vadi S, Minai OA, Gildea TR, Mehta AC. Respiration. 2009: 77(3):292-7. Epub 2009 Jan 28.
- Bronchoscopic Approach to COPD
Sahi H, Karnak D, Meli YM, Machuzak M, Gildea TR, Mehta AC. COPD. 2008 Apr: 5(2):125-31. Review.
- Management of Tracheomediastinal Fistula Using Self-expanding Metallic Stents
Choudhary C, Gildea TR, Salman R, Guzman ED, Mehta AC. Ann Thorac Surg. 2008 May: 85(5):1800-2.
- Impact of Anastomotic Airway Complications After Lung Transplantation
Murthy SC, Blackstone EH, Gildea TR, Gonzalez-Stawinski GV, Feng J, Budev M, Mason DP, Pettersson GB, Mehta AC. Members of Cleveland Clinic's Pulmonary Transplant Team. Ann Thorac Surg. 2007 Aug: 84(2):401-9, 409.e1-4.
Our Advanced Diagnostic and Interventional Bronchoscopy Program is committed to working with referring physicians. We consult with you up front, review cases within 48 hours and provide prompt follow-up on your patient. Our services are designed so you can choose the level of care your patients need, whether it is a single diagnostic bronchoscopy or a full-range of multidisciplinary services.
As a national referral center, our team is familiar with the challenges experienced by out-of-state patients, and we do our best to make their trip to Cleveland Clinic as seamless as possible. We will coordinate your patient's care between our physicians and schedule their appointments in a single day, whenever possible. Through the Cleveland Clinic Medical Concierge service, we also provide assistance with airline reservations and hotel accommodations to make their visit as easy as possible.
With the best possible treatment plans and coordinated care, our team approach benefits both the patient and the referring physician. Learn more about referring a patient online, or call toll-free 866.CCF.LUNG (223.5864).
Pulmonary and Critical Care Medicine Fellowships
Our pulmonary and critical care medicine fellowships provide board-certified general internists with the tools necessary to care for patients, who have complicated lung diseases and critical illnesses. During the three-year training period, which includes an 18-month core program and 18-month subspecialty track, fellows are exposed to a wide variety of medical problems in both the inpatient and outpatient settings. Learn more about our pulmonary and critical care medicine fellowships.
Cleveland Clinic Respiratory Institute offers continuing medical education courses through the Center for Continuing Education. We are providers of AMA-approved continuing medical education (CME) units for physicians and physician assistants, and of continuing education units by the Ohio Nurses Association for nurses and by the Ohio Respiratory Care Board for respiratory therapists.
Below are helpful articles written by our physicians, who have published extensively in the field and are invited frequently to speak around the world on topics in the field of bronchology.