Using the Endoscope for Endobronchial Ultrasound in the Esophagus

Area of Science:

• Pulmonology
• Interventional Pulmonology
• Gastroenterology

Background:

• Endoscopic ultrasound-bronchoscopy (EUS-B) utilizes an echoendobronchoscope for minimally invasive visualization and biopsy.
• It offers access to structures beyond traditional endoscopic ultrasound (EUS) and endobronchial ultrasound (EBUS).
• EUS-B is designed as a pulmonologist-friendly adaptation of EUS, leveraging existing EBUS expertise.

Purpose of the Study:

• To evaluate the safety and feasibility of EUS-B for pulmonologists.
• To assess the diagnostic expansion offered by EUS-B compared to existing methods.
• To highlight EUS-B's role in lung cancer diagnosis and staging.

Main Methods:

• The procedure involves introducing an echoendoscope through the nostril or mouth into the esophagus and stomach under conscious sedation.
• Key landmarks including the left liver lobe, abdominal aorta, left adrenal gland, and mediastinal lymph node stations (7, 4L, 4R) are identified using ultrasound.
• Biopsies are obtained via endoscopic ultrasound-guided fine needle aspiration (EUS-B-FNA), with a specific biopsy order to prevent upstaging.

Main Results:

• EUS-B is demonstrated as a safe and feasible procedure for experienced interventional pulmonologists.
• The technique provides access to retroperitoneal lymph nodes, ascites, and lesions in the liver, pancreas, and adrenal gland, which are not reachable by EBUS.
• It allows for real-time ultrasonographic guidance for biopsies, similar to EBUS-TBNA.

Conclusions:

• EUS-B significantly expands diagnostic possibilities for pulmonologists.
• It offers a safe, fast, and thorough method for the diagnosis and staging of lung cancer.
• Training in EUS-B is considered a natural progression from EBUS, facilitating adoption by pulmonologists.