A Novel Dual-Scope Method for Safe Endobronchial Ultrasound-Guided Transbronchial Mediastinal Cryobiopsy

Conventional endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TBMC) requires simultaneous withdrawal of the EBUS scope and cryoprobe to retrieve the specimen. This process complicates immediate haemostasis and frequently requires cumbersome intubation to ensure procedural safety. As airway haemorrhage can be fatal, a prompt response must always be ensured despite its rare occurrence. We have developed a novel dual-scope method for EBUS-TBMC. This technique involves the simultaneous transoral insertion of a thin bronchoscope for haemostasis alongside the EBUS scope for cryobiopsy without intubation. Immediate haemostasis under real-time visualisation was performed using a thin bronchoscope remaining in the airway after withdrawal of the EBUS scope. This approach eliminates the 'blind time' experienced in conventional methods, significantly enhancing overall procedural safety. Herein, we report a case of methotrexate-associated lymphoproliferative disorder (malignant lymphoma) that was successfully diagnosed using the dual-scope method.