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Combined EUS and EBUS are complementary methods in lung cancer staging: Do not forget the esophagus.

Vilmann P, Clementsen PF - Endosc Int Open (2015)

View Article: PubMed Central - PubMed

Affiliation: GastroUnit, Department of Surgery, Herlev University Hospital, DK 2730 Herlev, Denmark.

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Endoscopic ultrasound (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] and transesophageal ultrasound-guided fine needle aspiration [EUS-FNA]) can be performed in an outpatient setting under local anesthesia with mild sedation... Thus the two procedures are complementary (Fig.  1)... Currently no single endoscope offers the benefits of both endobronchial and transbronchial access... EUS is better tolerated (no cough), the ultrasonic window angle is larger (150 – 180 versus 50 – 60 degrees with EBUS), the ultrasonic image is better due to higher resolution, it allows better visualization of small structures, the operator can orientate independent of an endoscopic view with secretions, and the transducer is in close contact with the target, owing to endoscopic suction with deflation of the esophageal lumen... With EUS, there are also no hard cartilage rings interposed between the needle and the target and needle maneuverability is better with improved targeting due to an “elevator. ” All of these benefits are outweighed by a single disadvantage: the psychological barrier to use of EUS that exists among many—but not all—thoracic physicians... In their current paper, Meena and Bartter performed a retrospective comparison of EUS-B and EBUS in a total of 155 procedures and found that EUS-B was faster, patients needed less sedation and oxygen, and the time to discharge was shorter, whereas the diagnostic yield was the same... The authors conclude that EUS is the procedure of choice when applicable, meaning that, for example, EUS-B should be preferable to EBUS in a patient with a suspicious lymph node station 7 or 4 L... It should be mentioned that, for obvious reasons, several of the advantages of EUS listed above are not achievable with EUS – B... One example is superior ultrasonic visualization... It must also be noted, that in the current study, regions under the diaphragm relevant for staging of NSCLC (Fig.  1) could not be reached with the relatively short EUS – B technique, meaning that EUS does not get its full credit as a comparator in the study... If thoracic physicians are not to be left behind in terms of advancements in endoscopic ultrasound, it is mandatory that necessary education and training be established for EUS as well as EBUS, including theoretical courses, simulator-based education, and clinical training plus valid assessment of all three elements But do not forget the esophagus!

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 Illustration of mediastinal lymph node stations and abdominal regions reached by EUS and EBUS, respectively (Mountain-Dressler classification).
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FI299-1:  Illustration of mediastinal lymph node stations and abdominal regions reached by EUS and EBUS, respectively (Mountain-Dressler classification).

Mentions: Endoscopic ultrasound (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] and transesophageal ultrasound-guided fine needle aspiration [EUS-FNA]) can be performed in an outpatient setting under local anesthesia with mild sedation. The procedures are well established for diagnosis and staging of a variety of diseases, such as lung cancer 123. Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical treatment. By using endoscopic ultrasound, surgical staging procedures can be avoided in a considerable proportion of patients with NSCLC. In short, EUS is excellent for the left and lower paraesophageal structures plus structures under the diaphragm, whereas EBUS provides access to structures close to the large airways on both sides. Thus the two procedures are complementary (Fig. 1) 4.


Combined EUS and EBUS are complementary methods in lung cancer staging: Do not forget the esophagus.

Vilmann P, Clementsen PF - Endosc Int Open (2015)

 Illustration of mediastinal lymph node stations and abdominal regions reached by EUS and EBUS, respectively (Mountain-Dressler classification).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4554516&req=5

FI299-1:  Illustration of mediastinal lymph node stations and abdominal regions reached by EUS and EBUS, respectively (Mountain-Dressler classification).
Mentions: Endoscopic ultrasound (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] and transesophageal ultrasound-guided fine needle aspiration [EUS-FNA]) can be performed in an outpatient setting under local anesthesia with mild sedation. The procedures are well established for diagnosis and staging of a variety of diseases, such as lung cancer 123. Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical treatment. By using endoscopic ultrasound, surgical staging procedures can be avoided in a considerable proportion of patients with NSCLC. In short, EUS is excellent for the left and lower paraesophageal structures plus structures under the diaphragm, whereas EBUS provides access to structures close to the large airways on both sides. Thus the two procedures are complementary (Fig. 1) 4.

View Article: PubMed Central - PubMed

Affiliation: GastroUnit, Department of Surgery, Herlev University Hospital, DK 2730 Herlev, Denmark.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Endoscopic ultrasound (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] and transesophageal ultrasound-guided fine needle aspiration [EUS-FNA]) can be performed in an outpatient setting under local anesthesia with mild sedation... Thus the two procedures are complementary (Fig.  1)... Currently no single endoscope offers the benefits of both endobronchial and transbronchial access... EUS is better tolerated (no cough), the ultrasonic window angle is larger (150 – 180 versus 50 – 60 degrees with EBUS), the ultrasonic image is better due to higher resolution, it allows better visualization of small structures, the operator can orientate independent of an endoscopic view with secretions, and the transducer is in close contact with the target, owing to endoscopic suction with deflation of the esophageal lumen... With EUS, there are also no hard cartilage rings interposed between the needle and the target and needle maneuverability is better with improved targeting due to an “elevator. ” All of these benefits are outweighed by a single disadvantage: the psychological barrier to use of EUS that exists among many—but not all—thoracic physicians... In their current paper, Meena and Bartter performed a retrospective comparison of EUS-B and EBUS in a total of 155 procedures and found that EUS-B was faster, patients needed less sedation and oxygen, and the time to discharge was shorter, whereas the diagnostic yield was the same... The authors conclude that EUS is the procedure of choice when applicable, meaning that, for example, EUS-B should be preferable to EBUS in a patient with a suspicious lymph node station 7 or 4 L... It should be mentioned that, for obvious reasons, several of the advantages of EUS listed above are not achievable with EUS – B... One example is superior ultrasonic visualization... It must also be noted, that in the current study, regions under the diaphragm relevant for staging of NSCLC (Fig.  1) could not be reached with the relatively short EUS – B technique, meaning that EUS does not get its full credit as a comparator in the study... If thoracic physicians are not to be left behind in terms of advancements in endoscopic ultrasound, it is mandatory that necessary education and training be established for EUS as well as EBUS, including theoretical courses, simulator-based education, and clinical training plus valid assessment of all three elements But do not forget the esophagus!

No MeSH data available.