Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jul 31;15(7):3965-3973.
doi: 10.21037/jtd-22-1705. Epub 2023 Jun 27.

Safety and feasibility of oesophageal ultrasound for the work-up of thoracic malignancy in patients with respiratory impairment

Ida Skovgaard Christiansen  1   2 , Uffe Bodtger  1   2   3 , Rafi Nessar  2 , Goran Nadir Salih  2 , Shailesh Kolekar  2 , Jatinder Sing Sidhu  1   2 , Asbjørn Høegholm  1 , Christian B Laursen  4   5 , Arman Arshad  5 , Paul Frost Clementsen  1   2   6
Affiliations

Safety and feasibility of oesophageal ultrasound for the work-up of thoracic malignancy in patients with respiratory impairment

Ida Skovgaard Christiansen et al. J Thorac Dis. .

Abstract

Biopsying lung tumours with endobronchial access in patients with respiratory impairment is challenging. However, fine needle aspiration with the endobronchial ultrasound-endoscope via the oesophagus (EUS-B-FNA) makes it possible to obtain tissue samples without entering the airways. Safety of EUS-B-FNA in these patients has not earlier been investigated prospectively. Therefore, this study aimed at assessing feasibility and safety of EUS-B-FNA from centrally located tumours suspected of thoracic malignancy in patients with respiratory insufficiency. The study is a prospective observational study. Patients with indication of EUS-B-FNA of centrally located tumours and respiratory impairment defined as modified Medical Research Council (mMRC) dyspnoea scale score of ≥3, saturation ≤90% or need of continuous oxygen supply were included prospectively in three centres. Any adverse events (AEs) were recorded during procedure and 1-hour recovery. AEs were defined as hypoxemia (saturation <90% or need for increased oxygen supply) or any kind of events needing intervention. Late procedure-related events were recorded during 30-day follow-up. Between April 1, 2020 and January 30, 2021, 16 patients were included. No severe AEs (SAEs) occurred, but AEs were seen in 50% (n=8) and 13% (n=2) of the patients during procedure and recovery respectively. AEs included hypoxemia corrected with increased oxygen supply and in two cases reversal of sedation. Late procedure-related events were seen in 13% (n=2) and included prolonged need of oxygen and one infection treated with oral antibiotics. In this cohort, EUS-B-FNA of centrally located tumours was safe and feasible in patients with respiratory impairment, when examined in the bronchoscopy suite. A variety of mostly mild and manageable complications may occur, a few even up to 30 days post-procedure.

Keywords: Endobronchial ultrasound (EBUS); interventional pulmonology; lung cancer; respiratory insufficiency.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-1705/coif). ISC received unrestricted research grants from the following funds: the Danish Respiratory Society, Neye Fonden, Dagmar Marshalls Fond and Else og Mogens Wedell Wedellsborgs Fond. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Patient biopsied with EUS-B-FNA. (A) Patient with massive mediastinal masses prior to EUS-B-FNA. CT scan showed a mediastinal tumour with partial compression of the trachea, the left main bronchus and the left pulmonary artery causing respiratory impairment with increasing need of oxygen supply. The tumour was biopsied with EUS-B-FNA. (B) Effect of the treatment is shown in the CT scan 1 week after treatment initiation. The tumour size was reduced by half, respiratory condition had improved and the patient no longer needed supplementary oxygen. EUS-B-FNA, fine needle aspiration with the endobronchial ultrasound-endoscope via the oesophagus; CT, computed tomography.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Vilmann P, Clementsen PF, Colella S, et al. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer. European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur Respir J 2015;46:40-60. 10.1183/09031936.00064515 - DOI - PubMed
    1. Korevaar DA, Crombag LM, Cohen JF, et al. Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis. Lancet Respir Med 2016;4:960-8. 10.1016/S2213-2600(16)30317-4 - DOI - PubMed
    1. Skovgaard Christiansen I, Kuijvenhoven JC, Bodtger U, et al. Endoscopic Ultrasound with Bronchoscope-Guided Fine Needle Aspiration for the Diagnosis of Paraesophageally Located Lung Lesions. Respiration 2019;97:277-83. 10.1159/000492578 - DOI - PMC - PubMed
    1. Crombag LMM, Dooms C, Stigt JA, et al. Systematic and combined endosonographic staging of lung cancer (SCORE study). Eur Respir J 2019;53:1800800. 10.1183/13993003.00800-2018 - DOI - PubMed
    1. Meena N, Bartter T. Endosonography for mediastinal disease: esophageal ultrasound vs. endobronchial ultrasound. Endosc Int Open 2015;3:E302-6. 10.1055/s-0034-1392092 - DOI - PMC - PubMed