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. 2016 Aug;4(16):304. doi: 10.21037/atm.2016.08.40

Figure 1.

Figure 1

Fiberoptic bronchoscopy for the detection of the gastric pepsin (Pep-test) (10). The main risk of pepsin detection in bronchial secretions is the sucking of the salivary secretions. Secretions enter in the bronchial tree during the anaesthesia of the vocal cords and the tracheal introduction of the bronchoscope. It is necessary to standardise the procedure to reduce this risk: (I) perform an abundant nasal local anaesthetic (Lidocaine spray 10% in aqueous solution), not in the larynx; (II) insert the bronchoscope into the trachea slowly and, if possible, not introduce anaesthetic into the trachea; (III) proceed aspiration supporting the tip of the instrument on the front wall of trachea; (IV) if the specimen is not significant, wash the saline into the trachea and aspire in the middle and lower lobe and then repeat the manoeuvre on the left side; (V) after the Pep-test, complete the exam with Bronchoalveolar lavage for bacteriological examination. Available online: http://www.asvide.com/articles/1119