Even though the literature on their combined use mainly revolves around the staging of lung cancer, it also favors its use in benign processes.6 To date, however, there are no randomized studies comparing EBUS-TBNA head to head with EUS-FNA in patients with lesions accessible to both. In this issue of CHEST (see page 1259), Oki et al7 addresses this question. Patients with lesions accessible to both modalities, primarily in nodal stations 2L, 3p, 4L, 7, and/or adjacent masses, were randomized to either EBUS-TBNA or EUS-FNA. Procedures were performed under conscious sedation. Interestingly, the proceduralists were all pulmonologists, and a dedicated EBUS scope was used for both approaches. At face value, the study showed similar yield and patient satisfaction among both groups. Understandably, less topical anesthesia and sedation were required and there were less frequent desaturation events in EUS-FNA compared with the EBUS-TBNA group. The study, however, brings up broader issues; specifically, should the esophagus be accessed during EBUS procedures, and if so, who should be performing the procedure and using which scope?