A retrospective comparison of all endoscopic bronchial foreign body (BFB) removals performed at Children's Hospital and Medical Center, Seattle, Washington, during two separate 5-year periods is reported. There were 54 patients between July 1, 1964, and June 30, 1969, and 119 patients between July 1, 1984, and June 30, 1989. Bronchoscopic removal of foreign bodies in the late cohort was performed almost exclusively with Hopkins telescope-guided foreign body graspers as opposed to traditional forceps guided by the naked eye in the first group. There were no differences in the average age, foreign body type, anesthetic technique, operative length, or anatomic distribution between cohorts. There were significantly fewer complications in the late cohort than the early. Complication rates increased with the duration of the BFB in situ. There were significantly fewer missed BFBs at initial bronchoscopy in the late cohort (4) than the early (10). Inability to endoscopically remove the BFB resulted in thoracotomy in 3 patients in the early cohort and 1 patient in the late cohort. There was one instance in which foreign body migration from right to left main stem occurred during the delay between diagnosis and operation, resulting in the necessity for emergent bronchoscopy with the patient in extremis. Prompt endoscopy in patients with suspected BFBs using the Hopkins rod bronchoscopic system will result in fewer complications and fewer missed foreign bodies.