Feasibility of using the nasal route for linear endobronchial ultrasound

Linear endobronchial ultrasound (EBUS) is a safe and accurate diagnostic test for mediastinal adenopathy. Its feasibility through the nasal route has not been reported. The objective of this study was to document the feasibility of linear EBUS using the nasal route and compare its accuracy and safety with the oral route.

A retrospective analysis of consecutive subjects who underwent an EBUS procedure under conscious sedation at our center was conducted. Nasal insertion of the bronchoscope was attempted in all subjects; the oral route was used in case of failed nasal insertion. Characteristics of the procedure and the diagnostic accuracy of EBUS were compared between the two insertion routes.

From May to October 2012, 209 subjects underwent an EBUS. Complete data were available for 196 subjects. Nasal insertion of the EBUS bronchoscope was possible in 73.5 %. There was no difference between the two insertion routes in the location and number of stations sampled per subject. Procedure duration and complications (epistaxis, bronchial bleeding, desaturation, and pneumothorax) were similar between the two groups (2.1 % for nasal group vs 1.9 % for oral group). Minor epistaxis occurred in one subject in the nasal group. Comparing the nasal and oral groups, rates of adequate specimens were similar (90.5 vs 88.9 %, respectively; p = 0.68), and proportions of diagnostic specimens were not statistically different (51.4 vs 42.3 %, respectively; p = 0.26).

Linear EBUS can be performed safely and with high accuracy via the nasal route. Controlled studies are required to determine which insertion route provides best patient comfort.