Endobronchial Ultrasound Scope Research Articles

Safety and effectivity of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration in elderly patients.

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a well-established technique for assessing lesions near the central airway. While EBUS is typically used via the airway, the esophageal approach known as endoscopic ultrasound with bronchoscope-guided fine needle aspiration (EUS-B-FNA) has gained popularity for evaluating previously inaccessible lesions. This study aimed to assess the safety and diagnostic contribution of EUS-B-FNA in elderly patients. This retrospective study included elderly patients (≥65 years) who underwent EUS-B-FNA with concurrent convex probe-EBUS (C-EBUS) between June 2019 and December 2022. Inclusion criteria were age >64, having chest computed tomography (CT) or FDG-PET/CT, and undergoing C-EBUS, with the exclusion of patients with prior malignancy diagnoses and undergoing EBUS-TBNA. Among 68 patients who underwent combined EBUS and EUS-B-FNA, 31 met the inclusion criteria. The mean age was 71.7 years and 74.2% were male. All EUS-B-FNA material provided adequate material for histopathological analysis. Among patients, 67.7% received a malignancy diagnosis. Samples were obtained from mass lesions (58.1%) and lymph nodes (41.9%), primarily from the subcarinal (station 7) and left paratracheal (station 4L) regions. The mean number of needle passes was 2.83, with an average procedure duration of 9.4 min. No significant complications occurred. EUS-B-FNA is a safe and effective diagnostic method in elderly patients, offering an alternative when the transbronchial approach is not feasible. This underscores the importance of bronchoscopists' training in the transesophageal approach via EBUS scope.

Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities.

Endobronchial Ultrasound (EBUS) has been widely used to stage lung tumors and to diagnose mediastinal diseases. In the last decade, this procedure has evolved in several technical aspects, with new tools available to optimize tissue sampling and to increase its diagnostic yield, like elastography, different types of needles and, most recently, miniforceps and cryobiopsy. Accordingly, the indications for the use of the EBUS scope into the airways to perform the Endobronchial Ultrasound-TransBronchial Needle Aspiration (EBUS-TBNA) has also extended beyond the endobronchial and thoracic boundaries to sample lesions from the liver, left adrenal gland and retroperitoneal lymph nodes via the gastroesophageal tract, performing the Endoscopic UltraSound with Bronchoscope-guided Fine Needle Aspiration (EUS-B-FNA). In this review, we summarize and critically discuss the main indication for the use of the EBUS scope, even the more uncommon, to underline its utility and versatility in clinical practice.

Convex-probe Endobronchial Ultrasound: A Decade of Progress

Ever since the invention of the flexible bronchoscope, perhaps no other innovation in the field of interventional pulmonology has caused so much excitement the world over, as the convex probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA). While it took over a decade from 1992 to 2004 for the radial EBUS to evolve into the commercial convex probe EBUS scope, another exciting decade has gone by with the technology being thoroughly researched and appraised. The current evidence suggests that EBUS-TBNA can replace mediastinoscopy as the first investigation in the mediastinal staging of lung cancer. The use of EBUS-TBNA has been extended to several other areas including the diagnosis of undefined mediastinal lymphadenopathy, evaluation of intra-parenchymal lesions and others. In fact, EBUS-TBNA is the preferred modality for accessing mediastinal lesions in contact with the airways. The procedure not only has a high diagnostic efficiency (80%-90% for most indications) but is also safe compared to alternative options, such as image-guided fine needle aspiration and mediastinoscopy in the diagnosis of mediastinal lymphadenopathy. Apart from the traditional use of EBUS to perform TBNA, the last decade has seen the evolution of its transoesophageal use, development of novel EBUS-TBNA needles to obtain better histological specimens and a smaller EBUS scope. This review summarises the developments made in this field over the years since its inception.

PEDIATRIC SARCOIDOSIS: NOT SO UNCOMMON

TYPE: Late Breaking Abstract TOPIC: Pediatrics PURPOSE: Sarcoidosis is a multisystemic syndrome characterized by non-necrotizing granulomas involving multiple organ systems. Diagnosis requires a correlation of clinical, laboratory, radiological, cytological, and histological tissue examination. METHODS: This observational prospective study was conducted in Aster hospitals, Bangalore, India in a span of 1 years. Endobronchial ultrasound (EBUS) was carried out using curvilinear Olympus EBUS scope (BF-UC190F). Transbronchial biopsy was taken using a 21-gauge biopsy needle and sample was retrieved after subjecting to 3-5 jabs of needle per sampling and slides were prepared immediately and was sent for histopathological evaluation. RESULTS: A total of 41 children undervent EBUS-guided biopsy based upon mediastinal lymphadenopathy observed on chest CT. Of these, 6 children were diagnosed to have pediatric sarcoidosis based on the histopathological examination. CONCLUSIONS: Pediatric Sarcoidosis is a rare disease and should be kept as an important differential in cases with mediastinal lymphadenopathy. CLINICAL IMPLICATIONS: EBUS guided biopsy has proven to be an excellent modality in getting a histopathological diagnosis of this Sarcoidosis. DISCLOSURE: No significant relationships. KEYWORD: Pediatric Sarcoidosis

PRECLINICAL EVALUATION OF THIN CONVEX PROBE ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION FOR INTRAPULMONARY LESIONS

TOPIC: Procedures TYPE: Original Investigations PURPOSE: A prototype thin convex probe endobronchial ultrasound scope (TCP-EBUS; distal outer diameter [OD] 5.9 mm; Olympus Medical Systems Corp., Japan) was developed to enable access to distal airways and diagnose intrapulmonary lesions. The objective of this study was to evaluate the potential clinical utility of TCP-EBUS by preclinically assessing its bronchial accessibility, the feasibility of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) of intrapulmonary targets, as well as its short- and medium-term safety. METHODS: For bronchial accessibility, the TCP-EBUS was inserted into the distal airways of ex-vivo human lungs (n=5). TCP-EBUS was compared with several clinically-available bronchoscopes (BF-H190 bronchoscope, OD 5.5 mm; BF-Q190 bronchoscope, OD 4.8 mm; BF-Y0063 CP-EBUS scope, OD 6.6 mm, Olympus Medical Systems Corp., Japan). The maximum reach, in terms of bronchial generation, for each scope was documented using fluoroscopy and bronchoscopy. To quantify the minimum diameter of the distal airway accessed by the TCP-EBUS, an agarose-barium sulfate mixture was injected transbronchially to mark the bronchus where the TCP-EBUS could reach, followed by cone-beam CT to measure the diameter radiographically (n=3). For intrapulmonary lesion EBUS-TBNA feasibility, an agarose-barium mixture was injected transbronchially into the lungs in a live pig to create pseudo-tumor targets; successful EBUS-TBNA was based on retrieval of dyed agarose material. The short- (≤1 hr) and medium-term (≤10 d) safety of TCP-EBUS insertion and EBUS-TBNA in the periphery were observed physiologically and radiologically (fluoroscopy, computed tomography [CT]) in live pigs (n=5). RESULTS: For bronchial accessibility, TCP-EBUS demonstrated greater reach than the standard CP-EBUS in all bronchi, as well as surpassed the 5.5 mm-bronchoscope in 62.7% (131/209) and the 4.8 mm-bronchoscope in 27.2% (57/209) of assessed bronchi. The median bronchial generation and the mean diameter of bronchi TCP-EBUS reached was 4 (range 3-7) and 3.3±0.7 mm, respectively. No difficulties with EBUS-TBNA of intrapulmonary pseudo-tumors were observed. No major complications related to TCP-EBUS-TBNA in distal airways were observed in the five pigs. Scattered mucosal erythema of the bronchial walls was observed immediately after TCP-EBUS insertion in all pigs; this self-resolved by day 10. One pig developed an inflammatory scar in the right upper lobe by day 10. CONCLUSIONS: TCP-EBUS insertion appears to be safe and improves access to the distal airways. It has the potential to facilitate EBUS-TBNA of intrapulmonary lesions in the central and middle lung fields. CLINICAL IMPLICATIONS: Ultrasound-guided real-time sampling for intrapulmonary lesions located in the inner two-thirds lung fields may be safely conducted with the TCP-EBUS bronchoscope. DISCLOSURES: No relevant relationships by Masato Aragaki, source=Web Response No relevant relationships by Nicholas Bernards, source=Web Response No relevant relationships by Harley Chan, source=Web Response No relevant relationships by Zhenchian Chen, source=Admin input No relevant relationships by Andrew Effat, source=Web Response No relevant relationships by Alexander Gregor, source=Web Response No relevant relationships by Terunaga Inage, source=Web Response No relevant relationships by TSUKASA ISHIWATA, source=Web Response No relevant relationships by Tomonari Kinoshita, source=Web Response No relevant relationships by Yamato Motooka, source=Web Response no disclosure on file for Koichiro Tatsumi; No relevant relationships by Hideki Ujiie, source=Web Responseresearch support relationship with Olympus Corporation Please note: $5001 - $20000 by Kazuhiro Yasufuku, source=Web Response, value=Grant/Research Consultant relationship with Olympus America Inc Please note: $1001 - $5000 by Kazuhiro Yasufuku, source=Web Response, value=Consulting fee Consultant relationship with Medtronic Please note: $1001 - $5000 by Kazuhiro Yasufuku, source=Web Response, value=Consulting fee Consultant relationship with Johnson and Johnson Please note: $1001 - $5000 by Kazuhiro Yasufuku, source=Web Response, value=Consulting fee Consultant relationship with Auris Surgical Robotics Please note: $1001 - $5000 by Kazuhiro Yasufuku, source=Web Response, value=Consulting fee

Role of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration with Cellblocks in Diagnosis and Subtyping of Intrathoracic Lesions: Two Year Experience from a Tertiary Care Center.

Background:Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) allows precise real-time sampling of intrathoracic lesions and is a minimally invasive, safe, and cost effective technique with high diagnostic yield. The aim of the current study is to evaluate utility of EBUS-TBNA cytology with cellblocks (CBs) in the diagnosis and subtyping of the intrathoracic lesions.Materials and Methods:It was a prospective study conducted from October 2015 to October 2017. We received 233 cases of intrathoracic lesions for EBUS-TBNA, of which CB was made in 217 cases. A flexible endobronchial ultrasound scope was used to sample the lesions.Results:There were 89 females and 128 males amongst the total 217 patients (age range: 14–85 years, mean age: 48.35 years). The smears from EBUS-TBNA contained adequate material in 137/144 [95.1%] non-neoplastic cases and 34/36 [94.4%] of the neoplastic cases, whereas the CBs provided adequate material in 94/144 [65.3%] non-neoplastic cases and 37/40 [92.5%] neoplastic cases. The CB helped subtyping the malignancy in 19 cases and of these immunohistochemistry (IHC) was done on the CB in 15 cases. The biopsy was non-diagnostic in 17/36 cases of granulomatous pathology and 4/18 neoplastic cases diagnosed with EBUS-TBNA.3.Conclusions:EBUS-TBNA provides rapid diagnosis through cytology and the material recovered in the same setting for the CB preparation can be used for immunohistochemical analysis and it may at times provide the diagnosis in cases where the smears are non-diagnostic.

Performance of endobronchial-ultrasound guided miniforceps biopsy of targeted mediastinal and hilar lesions.

Performance of endobronchial-ultrasound guided miniforceps biopsy of targeted mediastinal and hilar lesions.

Endosonographic evaluation of the mediastinum through the i-gel O2 supraglottic airway device.

Endobronchial ultrasound (EBUS) is an endoscopic diagnostic procedure combining flexible fibrobronchoscopy with ultrasound techniques; it allows transbronchial needle aspiration biopsy for the diagnosis and staging of mediastinal masses. We present our preliminary experience with the use of the i-gel O2 supraglottic airway device for management of EBUS procedures. An observational study on 39 patients who underwent EBUS under general anesthesia was performed. Airways were managed with i-gel O2 by anesthesiologists unfamiliar with it. Data collected included patient characteristics, i-gel O2 positioning, mechanical ventilation, procedure, and complications occurring during and after the EBUS. The i-gel airway was successfully positioned during the first attempt in 34/39 cases (87.2%). No failed positioning was recorded. The EBUS scope easily passed through the i-gel in all patients and in 14 (35.6%) cases it was also inserted through the esophagus allowing the examination or fine needle aspiration of paraesophageal lymph nodes. In one case, during the EBUS procedure, the i-gel was dislocated but easily put in place again. During EBUS, air leakages were significant in 2 cases (5.1%) and minimal in 14 cases (35.9%). A brief self-solved laryngospasm and a bronchospasm during bronchoscopy were recorded. After recovery, no patients had dysphagia; mild odynophagia and pharyngodinia were referred by 2 (5.1%) and 12 (30.1%) patients, respectively. The i-gel O2 airway is easy to position and manage even for anesthesiologists unfamiliar with it. This supraglottic airway device is suitable for a complete endosonographic evaluation of the mediastinum.

Possible pseudotransmission of Enterobacter cloacae associated with an endobronchial ultrasound scope

During an investigation of positive environmental cultures with Enterobacter cloacae from an endobronchial ultrasound scope, possible pseudotransmission was discovered between 2 patients. All reprocessing steps were adhered to and the original equipment manufacture's quality control assessment of the scope could not determine the root cause. Our findings appear to be the first documented case of pseudotransmission from an endobronchial ultrasound scope and suggest bacterial transmission may exist in endoscopes without an elevator channel.

Endobronchial ultrasound: Echoing in the field of pediatrics.

Endobronchial ultrasound (EBUS) is a useful technique for the diagnosis and staging of the lung and mediastinal lesions, which is crucial for selecting treatment protocol. Under EBUS guidance, transbronchial needle aspiration (TBNA) is widely applied for obtaining specimens for histological, cytological, and molecular evaluation. Recently, the EBUS scope designed for adults has been used in large pediatric candidates. The presence of lung masses and mediastinal lymphadenopathy in the pediatric population presents a diagnostic challenge; however, EBUS is a promising tool for pediatricians to address these challenging issues. In some centers, the adult EBUS echobronchoscope is applied in transesophageal procedures for pediatric patients. EBUS-guided TBNA can also be used to perform minimally invasive interventional therapy, such as fiducial marker placement for assisting precision radiation, brachytherapy, and radiofrequency ablation therapy. With the development of EBUS equipment designed specifically for children, pediatric EBUS will play an increasingly important role.

Endobronchial Ultrasound Bronchoscope Damage.

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is an effective, safe, and cost-effective diagnostic bronchoscopy technique for the work-up of mediastinal lymphadenopathy. Concern has been raised, however, about the high cost of convex-probe EBUS bronchoscope repairs. The damage is usually due to breakage of the insertion tube (the flexible part that is advanced into the airways), moisture invasion and damages to the working channel, image guide bundle, or umbilical cord. Understanding the root cause of EBUS scope damage is important for its prevention. We describe 2 unusual cases of EBUS scope damage. In the first case, the distal black rubber covering of the EBUS scope insertion tube was damaged due to friction with the edge of an endotracheal tube and in the second case, the EBUS scope insertion tube was angulating laterally instead of vertically during the flexion maneuver, probably due to scope manipulation while wedged tightly in a segmental bronchus.

Left Adrenal Gland Analysis in Lung Cancer Patients Using the Endobronchial Ultrasound Scope: A Feasibility Trial

Background: In lung cancer patients, the adrenal glands are predilection sites for distant metastases. Esophageal endoscopic ultrasound - fine-needle aspiration (EUS-FNA) is a minimally invasive and accurate method for left adrenal gland (LAG) analysis but requires a conventional gastrointestinal echoendoscope. Complete endobronchial and esophageal mediastinal nodal staging can be achieved by just a single endobronchial ultrasound (EBUS) scope, introducing it into the esophagus (EUS-B) following the endobronchial procedure. Whether the LAG can also be assessed with the EBUS scope is unknown. Objectives: The aim of the study was to investigate the feasibility of identifying the LAG with the EBUS scope. Methods: We conducted a retrospective analysis of lung cancer patients who underwent EBUS and EUS-B for mediastinal staging and LAG assessment between January 2013 and May 2015. Results: A total of 143 patients with (suspected) lung cancer were investigated by the combination of EBUS and EUS-B. In 68 of the 80 patients (85%) in whom an attempt was made to identify the LAG, it was feasible to transgastrically detect the LAG with the EBUS scope. In 9 patients with endosonographic signs of malignant involvement, diagnostic transgastric FNAs were obtained in all. In the 12 patients (15%) in whom the LAG was not detected, the contact between the ultrasound transducer and the gastric wall was suboptimal - the length of the scope was not a limiting factor. Conclusions: The EBUS scope allows identification of the LAG in the vast majority of lung cancer patients. Implication: In patients with (suspected) lung cancer, in addition to complete hilar and mediastinal staging, LAG assessment using just a single EBUS scope also seems feasible. Prospective studies are indicated.

Imaging of spaces of neck and mediastinum by endoscopic ultrasound.

Endoscopic ultrasound (EUS) of the mediastinum was pioneered by gastroenterologists, and it was taken up by pulmonologists when the smaller-diameter endobronchial ultrasound (EBUS) scope was designed after a few years. The pulmonologists’ approach remained largely confined to entry from the trachea, but they soon realized that the esophagus was an alternative route of entry by the EBUS scope. The new generations of interventionists are facing the challenge of learning two techniques (EUS and EBUS) from two routes (esophagus and trachea). The International Association for the Study of Lung Cancer (IASLC) proposed a classification of mediastinal lymph nodes at different stations that lie within the boundaries of specific spaces. These interventionists need clear definitions of landmarks and clear techniques to identify the spaces. There are enough descriptions of spaces of the neck and the mediastinum in the literature, yet the topic mentioned above has never been discussed separately. The anatomical structures, landmarks, and boundaries of spaces will be important to interventionists in the near future during performances of endosonography. This article combines the baseline anatomy of the spaces with the actual imaging during EUS.

A novel technique of needle setting for curvilinear endobronchial ultrasound: Improved efficiency with no cost.

Background:Standard instructions for biopsy using the convex curvilinear endobronchial ultrasound scope include visualization and adjustment of the sheath housing the biopsy needle before every puncture. In our practice, we pre-set this relationship before inserting the endobronchial ultrasound scope and leave it fixed for every puncture.Objective:We postulated that this approach is more efficient than repeated re-adjustment and aimed to show that it would not increase the frequency of endobronchial ultrasound scope damage.Methods:Retrospective review of every biopsy using the endobronchial ultrasound scope over a 6-year period with documentation of damages and costs.Results:There were 15 scope damages out of 1792 procedures (0.8%). Eight damages were determined to be due to needle damage, one due to patient bite, three due to Williams airway abrasions, and three were camera failures. All damages occurred during the first 5 years of the study. Costs totaled US$138,725, for an average of US$23,120 per year. This rate of damages appears to be similar to or lower than that reported when standard instructions are followed.Conclusion:Pre-setting of the biopsy needle when the endobronchial ultrasound scope is used leads to greater efficiency and no increase in scope damages.

Exploration under the dome: Esophageal ultrasound with the ultrasound bronchoscope is indispensible.

Background:Effective use of the convex curvilinear ultrasound bronchoscope in the esophagus (EUS-B) for fine needle aspiration biopsy of mediastinal structures is now well described. In contrast, there is little to no reporting, depending on the site of EUS-B for access to sub-diaphragmatic structures. Our practice has been accessing sub-diaphragmatic sites for years. This review documents our experience with EUS-B to biopsy liver, left adrenal glands, and coeliac lymph nodes.Methods:After Institutional Review Board's approval, all endosonographic procedures performed by interventional pulmonary between July 2013 and June 2015 were reviewed. Those including biopsy of sub-diaphragmatic sites were then selected for analysis.Results:Over the study interval, 45 sub-diaphragmatic biopsy procedures (25 left adrenal glands, 7 liver, and 13 celiac node) were performed with EUS-B. In all cases, cellular adequacy was present, and samples were large enough for immunohistochemistry and any relevant ancillary studies. Metastatic malignancy was documented in 58% of cases, 16% of cases contained benign diagnostic findings, and in 27% of cases, normal organ tissue was documented. There were no complications.Conclusions:Operators comfortable with the endobronchial ultrasound scope in both the airway and the esophagus can actively seek and successfully perform biopsy of sub-diaphragmatic abnormalities when present and can thereby add to the diagnostic value of the procedure.

Transbronchial vs Transesophageal Needle Aspiration Using an Ultrasound Bronchoscope for the Diagnosis of Mediastinal Lesions: A Randomized Study

The purpose of this study was to compare the tolerance, efficacy, and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) with transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) with an endobronchial ultrasound scope for the first pathologic diagnosis of lesions accessible by both procedures. Patients who had lesions accessible by both EBUS-TBNA and EUS-FNA were enrolled and were randomized to undergo either procedure. Patients quantified tolerance, and operators charted the quality of examination using a 100-mm visual analog scale (VAS). A specific diagnosis was made in 50 of 55 patients (91%) in the EBUS-TBNA group and in 48 of 55 patients (87%) in the EUS-FNA group (P = .76). Compared with EBUS-TBNA, EUS-FNA was associated with a shorter duration of procedure (median, 15.3 min vs 11.3 min; P < .001), lower doses of IV midazolam (mean, 4.4 mg vs 4 mg; P = .02) and intraairway lidocaine (mean, 303 mg vs 189 mg; P < .001), less frequent oxygen desaturations (23 of 55 vs two of 55, P < .001), and higher operator satisfaction (P < .001). There was no significant difference in patient tolerance according to the patients' VAS. Lymph node infection occurred in one patient in the EBUS-TBNA group and in two patients in the EUS-FNA group. Both EBUS-TBNA and EUS-FNA provide high accuracy with good tolerance, although the occurrence of infectious complications should be monitored carefully. EUS-FNA has the advantage of comparable tolerance with fewer doses of anesthetics and sedatives, a shorter procedure time, and fewer oxygen desaturations during the procedure. UMIN Clinical Trials Registry; No.: UMIN000005757; URL: http://www.umin.ac.jp/ctr/.

The Identification of Stenotrophomonas maltophilia Contamination in Ultrasound Endoscopes and Reproduction of Decontamination Failure by Deliberate Soiling Tests

Background: An outbreak of Stenotrophomonas maltophilia was observed in the cultures of bronchial aspirations. After systematic culturing of the scopes and reprocessing the equipment, it turned out to be a pseudo-outbreak caused by a failure of the disinfector to sterilize ultrasound scopes, subsequently resulting in cross infection of the bronchoscopes via the connecting tubes in the dryer. Objectives: To support the above-mentioned findings and to show how different variables influence the decontamination process. Methods: The ultrasound scopes were deliberately contaminated with test soil and subsequently disinfected with peracetic acid (PAA), glutaraldehyde (GA) and hot water. Cultures were taken immediately after disinfection and after 4 days in the drying cabinet. Results: After disinfection with PAA, persistent contamination was observed in the endobronchial ultrasound scope, and after disinfection with PAA and prolonged storage in the drying cabinet, contamination of the endoscopic ultrasound scope persisted. All ultrasound scopes were effectively disinfected with GA. Conclusion: It is concluded that disinfection with PAA fails to decontaminate the small channels of the ultrasound scopes. Prolonged storage in humid conditions seems to enhance the outgrowth of microorganisms. By reassignment of all endoscopes to fixed locations in the drying cabinet, by using disposable connector tubes for the balloon channels, and by using GA instead of PAA, the reprocessing procedure in our hospital was corrected effectively.

Mo1348 Endobronchial Ultrasound (EBUS) in Esophageal and Esophagogastric Malignant Stenosis: an Added Value

Accurate staging is critical in esophageal and esophago-gastric junction cancer, to select the appropriate management algorithm. Endoscopic ultrasound (EUS) is widely accepted as the gold standard technique to approach mediastinal diseases, providing an accurate assessment of local staging of both tumor infiltration (T stage) and lymph node status (N stage). However, in up to 30% of cases, failure in crossing the tumor narrowing with the EUS standard scope has been reported, resulting in a less accurate staging assessment. Endoscopic bronchial ultrasound (EBUS) with its smaller caliber, can be passed through obstructive tumors, allowing both T and N staging, and fine needle aspiration of lymph nodes or tumor masses (FNA). Aim To assess the feasibility of EBUS in stricturing esophageal and esophago-gastric junction tumors and to evaluate the staging yield of this technique for selecting the appropriate treatment. Patients and Methods Between January 2013 and October 2013, all consecutive patients referred to our tertiary referral center for EUS staging of esophageal cancer, with tumor stenosis, prohibiting the passage of the linear standard echoendoscope were enrolled in the study. After a first EGD evaluation and attempt with standard linear echoendoscope (EG3870UTK, Pentax Medical, Tokyo, Japan), in case of stenosis, the Pentax EB1670UK broncho-videoechoendoscope was used, to complete the tumor staging. Fine needle aspiration of peri-lesional lymph nodes, was performed, when indicated. Results 81 consecutive patients (65 M, mean age 67.4 years) with esophageal or esophago-gastric junction cancer underwent EUS for tumor staging at our center. In 31/81 (38%) patients (22 M, mean age 66.6 years) due to stricturing lesions, the linear echoendoscope could not pass the tumor. In these cases, we used the EBUS scope to overcome the stricture and complete the T and N staging. We reported 21/31 (68%) cases of stricturing esophageal cancer, 8/31 (26%) esophago-gastric junction cancer and 2/31 (6%) cases of post-surgical anastomotic recurrence. The EBUS T-stage was: 2/31 (6%) uT1sm, 2/31 (6%) uT2, 15/31(49%) uT3, 12/31 (39%) uT4. The EBUS N-stage was: 4/31 (13%) N0, 10/31 (32%) N1, 17/31 (55%) N+. In 2 cases, we performed FNA of per-lesional limph nodes, to complete diagnosis. 5/31 patients underwent surgery. The pathological staging confirmed the EBUS staging in 4/5 (80%) cases, whereas in 1 case EBUS over-staged the lesion (uT2 vs pT1a). Conclusions The use of EBUS scope in esophageal and esophagogastric malignant stenosis is feasible and effective, allowing an accurate T and N staging of all lymphovascular stations. Furthermore, FNA complete the local staging, and address the patient to the appropriate treatment.

Endobronchial Ultrasound Image of Lung Abscess with Bronchial Fistulisation

A 79 year-old ex-smoker gentleman presented for a few months history of cough and dyspnoea on exertion. He was evaluated for persistent right lower lobe mass-like density with multiple chest-computed tomography (CT) scans (Figures 1a and 1b). He also received four courses of antibiotic and he underwent flexible bronchoscopy, which revealed swelling and narrowing of the right middle lobe with purulent discharge. Cytology and cultures were negative and the diagnosis remains uncertain. The patient was then referred for endobronchial ultrasound (EBUS) diagnostic procedure. Flexible bronchoscopy with EBUS showed mucosal oedema with erythema of the right hilar area and purulent discharge originating from the posterior wall of the proximal right middle lobe bronchus, which was consistent with bronchial fistulisation (Figures 1c and 1d). The EBUS scope, which was positioned in the right lower lobe revealed a heterogeneous mass posteromedially with multiple cystic-like large areas of hypoechogenicity most consistent with abscesses formation (Figure 1e). Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of this mass revealed purulent discharge and grew streptococcus mitis/oralis. Six weeks of intravenous ertapenem treatment was ineffective

Assessment of the New Thin Convex Probe Endobronchial Ultrasound Scope: A Preliminary Study in the Porcine Lung

Assessment of the New Thin Convex Probe Endobronchial Ultrasound Scope: A Preliminary Study in the Porcine Lung