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Abstract

Medicine

Using the Endoscope for Endobronchial Ultrasound in the Esophagus

Published: November 21st, 2023

DOI:

10.3791/65741

1Pulmonary Research Unit (PLUZ), Department of Respiratory Medicine, Zealand University Hospital, 2Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen University Hospital, Rigshospitalet, 3Department of Respiratory Medicine, Odense University Hospital, 4Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, 5Department of Surgery, Copenhagen University Hospital, 6Department of Clinical Medicine, University of Copenhagen, 7Department of Pathology, Copenhagen University Hospital, Rigshospitalet, 8Department of Respiratory Medicine, University Medical Center, University of Amsterdam, 9Institute for Regional Health Research, University of Southern Denmark

Abstract

EUS-B is a procedure using the echoendobronchoscope in the esophagus and stomach. The procedure is a minimally invasive, safe, and feasible approach that pulmonologists can use to visualize and biopsy structures adjacent to the esophagus and stomach. EUS-B gives access to many structures of which some may also be reached by EBUS (mediastinal lymph nodes, lung or pleural tumors, pericardial fluid) while others cannot be reached such as retroperitoneal lymph nodes, ascites, and lesions in the liver, pancreas or left adrenal gland. The procedure is a pulmonologist- and patient- friendly version of the gastroenterologists' EUS using the thin EBUS endoscope that the pulmonologist already masters. Thus EUS-B training should be easy and a natural continuation of EBUS. With the patient under conscious sedation and in the supine position, the echoendoscope is introduced either through the nostril or mouth into the oropharynx. Then the patient is encouraged to swallow while the endoscope is slowly bent posteriorly and introduced into the esophagus and stomach. Using the ultrasonic image, the operator identifies the six landmarks by EUS-B and EUS: the left liver lobe, abdominal aorta (with the celiac trunk and superior mesenteric artery), left adrenal gland, and mediastinal lymph node stations 7, 4L, and 4R. Biopsies can be taken from suspected lesions under real-time ultrasonographic guidance- fine needle aspiration (EUS-B-FNA) using a technique similar to that used with EBUS-TBNA. The biopsy order is M1b-M1a-N3-N2-N1-T (M = metastasis, N = lymph node, T = tumor) to avoid iatrogenic upstaging. Pre- and post-procedural observation is similar to that of bronchoscopy. EUS-B is safe and feasible in the hands of experienced interventional pulmonologists and provides a significant expansion of the diagnostic possibilities in providing safe, fast, and thorough diagnosis and staging of lung cancer.

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Keywords Endobronchial Ultrasound EBUS

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