Utility & safety of endoscopic ultrasound guided sampling of mediastinal nodes or lesions with bronchoscope(EUSB)

Introduction: Endobronchial Ultrasound Guided Transbronchial Needle aspiration (EBUS-TBNA) is a firmly established modality for diagnostic evaluation of mediastinal lesions. Transesophageal approach for fine needle aspiration of mediastinal lesions using the Endobronchial Ultrasound scope has been described as a safe and efficacious modality.We performed a prospective randomized study of utility & safety of Transesophageal (EUS-B-FNA) approach for fine needle aspiration using the same EBUS scope in patients referred for endosonographic evaluation of mediastinal lesions. Methods: Subjects undergoing EBUS-TBNA were enrolled after taking a written informed consent. EUSB FNAC was done in patients where the mediastinal lesion could not be visualized endobronchially with EBUS or had intolerance to bronchoscopy. Results: 60 lymph nodes or mediastinal lesions were sampled via the esophagus with the EBUS scope in 55 patients, majority being subcarinal lymph nodes(39), mediastinal lesions(12), left paratracheal lymph nodes(6), right paratracheal lymph nodes (2) & 1 paraesophageal node. The most common reason for switching to the esophageal route was either intolerance of bronchoscopy due to cough (30), deasturation (5) or endobronchial bleed(6) & better visualized areas by EUS-B-FNA inaccessible by EBUS-TBNA(14). The average size of the node or mass was 20x14.6mm. No complications seen. Operator and patient comfort was seen to be significantly better with EUS-B-FNA. Need for sedation was also noted to be lower. Conclusion: This study confirmed the safety & efficacy of this technique especially in patients with poor tolerance to bronchoscopy & bronchoscopically invisible lesions.