Safety of EUS-B-FNA in patients with respiratory insufficiency

Abstract

To biopsy centrally located lung tumors is a challenge, especially in patients with severe respiratory insufficiency. The endobronchial ultrasound guided fine needle aspiration performed through the esophagus (EUS-B-FNA) makes it possible to attain tissue samples without entering the airways, but safety in patients with respiratory insufficiency has not earlier been investigated. Therefore, this study aimed at assessing feasibility and safety of EUS-B-FNA from centrally located lesions suspected of lung cancer in patients with respiratory insufficiency. <b>Method:</b> patients with indication for EUS-B-FNA of a centrally located tumor and existing respiratory insufficiency defined as mMRC≥3, saturation ≤90% or need of continuous oxygen supply were included prospectively from three centers. Any adverse events (AE) were recorded during procedure and one-hour recovery. AEs were defined as hypoxemia (saturation &lt;90% or need for increased oxygen supply) or any kind of events needing intervention. Serious AE (SAE) were all AEs with escalation in level of care. Late procedure-related events were recorded during 30-days follow-up. <b>Results:</b> Between April 1, 2020 and January 30, 2021, 16 patients were included. No SAEs occurred, but AEs were seen in 50% (n=8) and 13% (n=2) of the patients during procedure and recovery respectively. AEs included hypoxemia corrected with increased oxygen supply and in two cases reversal of sedation. Late procedure-related events were seen in 13% (n=2) and included prolonged need of oxygen and one infection treated with oral antibiotics. <b>Conclusion:</b> EUS-B-FNA is a safe procedure in patients with respiratory insufficiency and all AEs during procedure and recovery were handled with standard care interventions.