To ensure the safety and accuracy of the procedure, training is essential. In the esophagus, there are no endoscopic landmarks like the carina in the airway, so we must confirm the exact location only by the ultrasound image. As Drs Annema and Konge commented, the challenge to mastering the procedure for pulmonologists, who are familiar with EBUS-TBNA, may be learning the mediastinal anatomy on the ultrasound image through the esophagus rather than acquiring the needle aspiration technique. A standard training protocol (including structured curriculum, simulation, and the assessment of technical skills or competency), which attaches importance to the ultrasound image of mediastinal structures through the esophagus, is needed. Until the way of training is established, pulmonologists should acquire substantial skills in EBUS-TBNA and training from an expert gastroenterologist prior to performing the EUS-FNA procedure; then, it should be performed under the supervision of an expert operator.