Abstract
BackgroundWith the recent widespread use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), there have been occasional reports on complications associated with its use. Previous reviews on EBUS-TBNA have been limited to studies by skilled operators, thus the results may not always be applicable to recent clinical practice. To assess the safety of EBUS-TBNA for the staging and diagnosis of lung cancer in Japan, a nationwide survey on its current usage status and complications associated with its use was conducted by the Japan Society for Respiratory Endoscopy (JSRE).MethodsA questionnaire about EBUS-TBNA performed between January 2011 and June 2012 was mailed to 520 JSRE-accredited facilities.ResultsResponses were obtained from 455 facilities (87.5%). During the study period, EBUS-TBNA was performed in 7,345 cases in 210 facilities (46.2%) using a convex probe ultrasound bronchoscope, for 6,836 mediastinal and hilar lesions and 275 lung parenchymal lesions. Ninety complications occurred in 32 facilities. The complication rate was 1.23% (95% confidence interval, 0.97%-1.48%), with hemorrhage being the most frequent complication (50 cases, 0.68%). Infectious complications developed in 14 cases (0.19%) (Mediastinitis, 7; pneumonia, 4; pericarditis, 1; cyst infection, 1; and sepsis, 1). Pneumothorax developed in 2 cases (0.03%), one of which required tube drainage. Regarding the outcome of the cases with complications, prolonged hospitalization was observed in 14 cases, life-threatening conditions in 4, and death in 1 (severe cerebral infarction) (mortality rate, 0.01%). Breakage of the ultrasound bronchoscope occurred in 98 cases (1.33%) in 67 facilities (31.9%), and that of the puncture needle in 15 cases (0.20%) in 8 facilities (3.8%).ConclusionsAlthough the complication rate associated with EBUS-TBNA was found to be low, severe complications, including infectious complications, were observed, and the incidence of device breakage was high. Since the use of EBUS-TBNA is rapidly expanding in Japan, an educational program for its safe performance should be immediately established.
Highlights
With the recent widespread use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-Transbronchial needle aspiration (TBNA)), there have been occasional reports on complications associated with its use
The questionnaire included specific questions regarding the number of cases examined by EBUSTBNA, the characteristics of the cases, and the complications of EBUS-TBNA performed using a convex probe ultrasound bronchoscope during the preceding 18 months (January 2011 through June 2012)
The investigated complications included hemorrhage that required treatments other than aspiration, compression and cold physiological saline injection, pneumonia, mediastinitis, pericarditis, other infectious complications, pneumothorax requiring bed rest or thoracic drainage, lidocaine intoxication requiring special intervention because of convulsions/loss of consciousness, bronchial asthma, respiratory failure, and complications related to the circulatory system requiring special treatment, among others
Summary
With the recent widespread use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), there have been occasional reports on complications associated with its use. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) performed using a convex probe ultrasound bronchoscope is a minimally invasive diagnostic method for peritracheal and peribronchial lesions [1]. The introduction of EBUS-TBNA has resulted in cost benefit in terms of minimally invasive lung cancer staging [8,9]. EBUS-TBNA has effectively been replacing mediastinoscopy for the staging of lung cancer and in establishing a definitive diagnosis of mediastinal and hilar lymphadenopathy owing to its high diagnostic rate, minimal invasiveness, and cost benefit. The background, procedural factors, and outcomes of these cases are described below
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