Endosc Int Open 2015; 03(04): E302-E306
DOI: 10.1055/s-0034-1392092
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Endosonography for mediastinal disease: esophageal ultrasound vs. endobronchial ultrasound

Nikhil Meena
University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, United States
,
Thaddeus Bartter
University of Arkansas for Medical Sciences and Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, United States
› Author Affiliations
Further Information

Publication History

submitted 12 December 2014

accepted after revision 23 March 2015

Publication Date:
21 May 2015 (online)

Background and study aims: One can approach mediastinal pathology via esophageal ultrasound (EUS) and/or endobronchial ultrasound (EBUS). It has been suggested that EUS is better tolerated by patients. If so, EUS might be the procedure of choice when suspect lesions are accessible via EUS. We studied procedural characteristics of EUS with fine needle aspiration (EUS-FNA) and EBUS with transbronchial needle aspiration (EBUS-TBNA) to see how they differed.

Patients and methods: Retrospective review of consecutive EBUS and EUS procedures performed on patients over nine months. One hundred fifty-five procedures were analyzed (61 EUS, 73 EBUS, 21 EUS + EBUS). For EUS, EBUS, and EUS + EBUS, 1.4, 2.0 and 2.5 sites (mean) were sampled, respectively. EUS required approximately one-half of the time of EBUS or the combined procedures; 13.1 vs. 24.1 and 26.9 min, respectively (P < 0.0001 for EUS vs. both EBUS and EUS + EBUS). Sedation dosing was statistically lower for EUS and not significantly different between EBUS and the combined approach. EUS also involved lower oxygen requirements and shorter time to discharge. Because fewer mean sites were sampled with EUS than with EBUS or the combined procedure, we performed analysis restricted to procedures that involved sampling of ≤ 2 sites to determine whether approach-related differences in procedure characteristics were preserved. There were 56 such EUS procedures and 52 such EBUS procedures. EUS remained significantly faster and required less patient sedation.

Conclusions: EUS involved statistically significant economies of time and sedation. This has implications with respect to safety and productivity. When applicable, EUS is the procedure of choice.

 
  • References

  • 1 Vilmann P, Larsen SS. Endoscopic ultrasound-guided biopsy in the chest: little to lose, much to gain. Eur Respir J 2005; 25: 400-401
  • 2 Abouzgheib W, Nahra R, Homsi S et al. Safety and feasibility of identifying and sampling of mediastinal structures through the esophagus using EBUS. Chest 2009; DOI: 10.1378/chest.136.4_MeetingsAbstracts.110S-b.
  • 3 Hwangbo B, Lee HS, Lee GK et al. Transoesophageal needle aspiration using a convex probe ultrasonic bronchoscope. Respirology 2009; 14: 843-849
  • 4 Herth FJ, Krasnik M, Kahn N et al. Combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration of mediastinal lymph nodes through a single bronchoscope in 150 patients with suspected lung cancer. Chest 2010; 138: 790-794
  • 5 Hwangbo B, Lee GK, Lee HS et al. Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest 2010; 138: 795-802
  • 6 Abouzgheib W, Shweihat Y, Bartter T. Oesophageal applications of the convex curvilinear ultrasound bronchoscope; an illustrative patient series. Respirology 2011; 16: 965-968
  • 7 Annema JT, Bohoslavsky R, Burgers S et al. Implementation of endoscopic ultrasound for lung cancer staging. Gastrointest Endosc 2010; 71: 64-70 , 70 e61
  • 8 Wang KP, Feller-Kopman D, Mehta A et al. Endobronchial ultrasound and esophageal ultrasound: just because we can, does not necessarily mean we should. Chest 2011; 140: 271-272 ; author reply 272 – 273
  • 9 Vilmann P, Hancke S, Henriksen FW et al. Endosonographically-guided fine needle aspiration biopsy of malignant lesions in the upper gastrointestinal tract. Endoscopy 1993; 25: 523-527
  • 10 Silvestri GA, Hoffman BJ, Bhutani MS et al. Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer. Ann Thorac Surg 1996; 61: 1441-1445 ; discussion 1445 – 1446
  • 11 Krasnik M, Vilmann P, Larsen SS et al. Preliminary experience with a new method of endoscopic transbronchial real time ultrasound guided biopsy for diagnosis of mediastinal and hilar lesions. Thorax 2003; 58: 1083-1086
  • 12 Kang HJ, Hwangbo B, Lee GK et al. EBUS-centred versus EUS-centred mediastinal staging in lung cancer: a randomised controlled trial. Thorax 2013; DOI: 10.1136/thoraxjnl-2013-203881.
  • 13 Oki M, Saka H, Ando M et al. Transbronchial versus yransesophageal needle aspiration Uusing an ultrasound bronchoscope for the diagnosis of mediastinal lesions: a randomized study. Chest 2014; DOI: 10.1378/chest.14-1283.
  • 14 Medford AR, Agrawal S. Single bronchoscope combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration for tuberculous mediastinal nodes. Chest 2010; 138: 1274
  • 15 Araya T, Demura Y, Kasahara K et al. Usefulness of transesophageal bronchoscopic ultrasound-guided fine-needle aspiration in the pathologic and molecular diagnosis of lung cancer lesions adjacent to the esophagus. J Bronchology Interv Pulmonol 2013; 20: 121-126
  • 16 Annema JT, Rabe KF. Endosonography for lung cancer staging: one scope fits all?. Chest 2010; 138: 765-767
  • 17 Vilmann P, Krasnik M, Larsen SS et al. Transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy: a combined approach in the evaluation of mediastinal lesions. Endoscopy 2005; 37: 833-839
  • 18 Rintoul RC, Skwarski KM, Murchison JT et al. Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging. Eur Respir J 2005; 25: 416-421
  • 19 Wallace MB, Pascual JM, Raimondo M et al. Minimally invasive endoscopic staging of suspected lung cancer. JAMA 2008; 299: 540-546
  • 20 Polkowski M, Larghi A, Weynand B et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy 2012; 44: 190-206
  • 21 von Bartheld MB, van Breda A, Annema JT. Complication rate of endosonography (endobronchial and endoscopic ultrasound): a systematic review. Respiration 2014; 87: 343-351
  • 22 Oki M, Saka H, Kitagawa C et al. Prospective study of endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes versus transbronchial lung biopsy of lung tissue for diagnosis of sarcoidosis. J Thorac Cardiovasc Surg 2012; 143: 1324-1329