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Pulmonary Procedures |

Randomized Study of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) Versus Transesophageal Endoscopic Ultrasound With Bronchoscope-Guided Fine Needle Aspiration (EUS-B-FNA) for the Diagnosis of Lesions Adjacent to Both the Trachea/Bronchus and Esophagus

Masahide Oki, PhD; Hideo Saka, MD; Chiyoe Kitagawa, PhD; Yoshihito Kogure, MD; Misaki Ryuge, MD; Saori Oka, MD; Takashi Adachi, MD; Rie Tsuboi, MD; Masashi Nakahata, MD; Kazumi Hori, MD; Masahiko Ando, PhD
Author and Funding Information

Nagoya Medical Center, Nagoya, Japan


Chest. 2013;144(4_MeetingAbstracts):822A. doi:10.1378/chest.1703989
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Abstract

SESSION TITLE: EBUS: New Insights

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, October 27, 2013 at 04:15 PM - 05:15 PM

PURPOSE: The purpose of this study was to compare the tolerance, efficacy and safety of EBUS-TBNA versus EUS-B-FNA for the diagnosis of hilar/mediastinal/parenchymal lesions which can be accessible through both the trachea/bronchus and esophagus.

METHODS: One hundred ten patients who had hilar/mediastinal/parenchymal lesions adjacent to both the trachea/bronchus and esophagus were enrolled in this study and randomized to undergo EBUS-TBNA or EUS-B-FNA under local anesthesia with lidocaine and conscious sedation with intravenous midazolam. Patients quantified tolerance and operators charted the quality of examination using a 100-mm visual analogue scale (VAS).

RESULTS: The specific diagnosis was made in 50 of 55 patients (91%) in the EBUS-TBNA group and in 48 of 55 patients (87%) in the EUS-B-FNA group. EUS-B-FNA was associated with shorter duration of the procedure (mean 16 min vs 12 min, p < 0.001), lower doses of midazolam (mean 4.3 vs 4 mg, p = 0.047) and lidocaine (mean 306 vs 189 mg, p < 0.001), less frequent oxygen desaturations (23/55 vs 2/55, p < 0.001), lower scores of cough (p = 0.04), pain (p = 0.03), dyspnea (p = 0.02) according to the patient’s VAS, and higher operator’s satisfaction according to the operator’s VAS (p = 0.001), compared with EBUS-TBNA. There was no significant difference in patient’s comfort, satisfaction, vomiting and willingness to have a repeat procedure, according to the patient’s VAS. Mediastinal abscess occurred in 1 of the EBUS-TBNA group and 2 of the EUS-B-FNA group.

CONCLUSIONS: Both EBUS-TBNA and EUS-B-FNA provide high accuracy with good tolerance, though the occurrence of infectious complications should be monitored carefully. EUS-B-FNA has the advantage of less frequent respiratory symptoms or oxygen desaturations during the procedure.

CLINICAL IMPLICATIONS: EUS-B-FNA may be a useful alternative to EBUS-TBNA in the diagnosis of lesions located adjacent to both the trachea/bronchus and esophagus.

DISCLOSURE: The following authors have nothing to disclose: Masahide Oki, Hideo Saka, Chiyoe Kitagawa, Yoshihito Kogure, Misaki Ryuge, Saori Oka, Takashi Adachi, Rie Tsuboi, Masashi Nakahata, Kazumi Hori, Masahiko Ando

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