The use of an ultrasound bronchoscope in the esophagus broadens the number of choices of endoscopic procedures in mediastinal staging. Conventional endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is traditionally performed by gastroenterologists. The advantages of respiratory physicians performing EUS-FNA in lung cancer staging have been discussed.2,3 Availability of the EUS-B-FNA procedure may change the approach used by bronchoscopists to stage lung cancer. We evaluated the additional gain provided by EUS-B-FNA when done after EBUS-TBNA. However, EUS-B-FNA can be used as a first-line examination method in a combined EBUS-EUS approach. EUS-FNA is a better-tolerated procedure than EBUS-TBNA. EUS-B-FNA can be readily coupled with bronchoscopic procedures when bronchoscopy is difficult because of severe cough, dyspnea, cardiac problems, or other conditions.4 However, dedicated training in transesophageal examination procedures is mandatory.