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Correspondence |

Endoscopic Ultrasound Training for Pulmonologists FREE TO VIEW

Jouke T. Annema, MD, PhD; Lars Konge, MD, PhD
Author and Funding Information

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDepartment of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands

bCenter of Clinical Education, University of Copenhagen, Copenhagen, Denmark

CORRESPONDENCE TO: Jouke T. Annema, MD, PhD, Department of Respiratory Medicine, Academic Medical Center, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4):984-985. doi:10.1016/j.chest.2015.10.023
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Published online

We read with great interest in a recent issue of CHEST (May 2015) the study by Oki and colleagues who compared mediastinal nodal sampling by endoscopic ultrasound (EUS; transesophageal) with endobronchial ultrasound (EBUS; transbronchial) using the same endoscope. Sampling by EUS resulted in similar diagnostic yield but was associated with fewer doses of anesthetics and sedatives, less oxygen desaturation and cough, a shortened procedure time, and higher operator satisfaction. We congratulate Oki and colleagues as they have proven what each EBUS/EUS endoscopist already knew from clinical practice but was never systematically investigated.

Not mentioned in the article is the fact that patients with lung cancer often also have COPD with a compromised pulmonary function. It is obvious that an esophageal approach is less troublesome for those patients. However, it needs to be stressed that the EUS approach is excellent for diagnostic purposes but not for complete mediastinal staging for which the combined EBUS and endoscopic ultrasound using the EBUS scope approach is advised. As recently discussed in CHEST, the question now is not whether to implement EUS (B) in pulmonary practice but how to organize training and implementation. The challenge to mastering EUS (B) is not the actual sampling, but learning the mediastinal anatomy from an esophageal perspective and relating the various lymph nodes to the vascular structures and the lymph node map. We demonstrated that pulmonologists can learn EUS and achieve similar results as experts using a dedicated implementation strategy. In another study, assessing learning curves for mediastinal EUS, we found that pulmonologists with knowledge of lung cancer staging and experience in bronchoscopy quickly improved their performance in EUS-guided fine-needle aspiration. However, acquisition of skill varied considerably between individuals and 20 procedures were not enough to ensure consistent and competent performance. To facilitate the learning of mediastinal EUS, we developed an EUS assessment tool and demonstrated that competency in mediastinal staging of non-small-cell lung carcinoma could be assessed in a reliable and valid way. Measuring and defining competency and training requirements could improve EUS quality and benefit patient care.

The results of Oki and colleagues underline that the pulmonary community needs to adopt mediastinal EUS. This should be taken up by pulmonologists–not gastroenterologists–and EBUS training should include EUS (B) at least for nodal stations 4L and 7. The evidence and the tools are there: it is time for EUS (B) implementation to ensure that more patients will benefit from this elegant diagnostic technique.

References

Oki M. .Saka H. .Ando M. .et al Transbronchial vs transesophageal needle aspiration using an ultrasound bronchoscope for the diagnosis of mediastinal lesions: a randomized study. Chest. 2015;147:1259-1266 [PubMed]journal. [CrossRef] [PubMed]
 
Annema J.T. . When will we finally adopt endoscopic ultrasound? Chest. 2014;146:e117- [PubMed]journal
 
Annema J.T. .Bohoslavsky R. .Burgers S. .et al Implementation of endoscopic ultrasound for lung cancer staging. Gastrointest Endosc. 2010;71:64-70 [PubMed]journal. [CrossRef] [PubMed]
 
Konge L. .Annema J. .Vilmann P. .Clementsen P. .Ringsted C. . Transesophageal ultrasonography for lung cancer staging: learning curves of pulmonologists. J Thorac Oncol. 2013;8:1402-1408 [PubMed]journal. [CrossRef] [PubMed]
 
Konge L. .Vilmann P. .Clementsen P. .Annema J.T. .Ringsted C. . Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer. Endoscopy. 2012;44:928-933 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Oki M. .Saka H. .Ando M. .et al Transbronchial vs transesophageal needle aspiration using an ultrasound bronchoscope for the diagnosis of mediastinal lesions: a randomized study. Chest. 2015;147:1259-1266 [PubMed]journal. [CrossRef] [PubMed]
 
Annema J.T. . When will we finally adopt endoscopic ultrasound? Chest. 2014;146:e117- [PubMed]journal
 
Annema J.T. .Bohoslavsky R. .Burgers S. .et al Implementation of endoscopic ultrasound for lung cancer staging. Gastrointest Endosc. 2010;71:64-70 [PubMed]journal. [CrossRef] [PubMed]
 
Konge L. .Annema J. .Vilmann P. .Clementsen P. .Ringsted C. . Transesophageal ultrasonography for lung cancer staging: learning curves of pulmonologists. J Thorac Oncol. 2013;8:1402-1408 [PubMed]journal. [CrossRef] [PubMed]
 
Konge L. .Vilmann P. .Clementsen P. .Annema J.T. .Ringsted C. . Reliable and valid assessment of competence in endoscopic ultrasonography and fine-needle aspiration for mediastinal staging of non-small cell lung cancer. Endoscopy. 2012;44:928-933 [PubMed]journal. [CrossRef] [PubMed]
 
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