<meta charset="utf8"></head><body>Integrando ultrassom transesofágico com ecoendobroncoscópio

<ol>
	<li>Crombag, L. M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ebus+Versus+Eus-B+for+diagnosing+sarcoidosis:+The+International+Sarcoidosis+Assessment+(ISA)+randomized+clinical+trial.">Ebus Versus Eus-B for diagnosing sarcoidosis: The International Sarcoidosis Assessment (ISA) randomized clinical trial.</a> Respirology. 27 (2), 152-160 (2022).</li><li>Vilmann, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+endobronchial+and+esophageal+endosonography+for+the+diagnosis+and+staging+of+lung+cancer:+European+Society+of+Gastrointestinal+Endoscopy+(ESGE)+Guideline,+in+cooperation+with+the+European+Respiratory+Society+(ERS)+and+the+European+Society+of+Thoracic+Surgeons+(ESTS).">Combined endobronchial and esophageal endosonography for the diagnosis and staging of lung cancer: European Society of Gastrointestinal Endoscopy (ESGE) Guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS).</a> Endoscopy. 47 (6), 545-559 (2015).</li><li>Pais, F. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transesophageal+approach+to+lung,+adrenal+biopsy+and+fiducial+placement+using+endoscopic+ultrasonography+(EUS):+An+interventional+pulmonology+experience.+Initial+experience+of+the+UCSF-FRETOC+(fresno+tracheobronchial+&amp;+oesophageal+center)+study+group.">Transesophageal approach to lung, adrenal biopsy and fiducial placement using endoscopic ultrasonography (EUS): An interventional pulmonology experience. Initial experience of the UCSF-FRETOC (fresno tracheobronchial &amp; oesophageal center) study group.</a> Respair Med. 141, 52-55 (2018).</li><li>Bhatia, S., Puri, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Role+of+endoscopic+ultrasound+in+non-small+cell+lung+cancer.">Role of endoscopic ultrasound in non-small cell lung cancer.</a> Int J Gastrointest Interv. 5 (3), 187-192 (2016).</li><li>Clementsen, P. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+and+staging+of+lung+cancer+with+the+use+of+one+single+echoendoscope+in+both+the+trachea+and+the+esophagus:+A+practical+guide.">Diagnosis and staging of lung cancer with the use of one single echoendoscope in both the trachea and the esophagus: A practical guide.</a> Endosc Ultrasound. 10 (5), 325-334 (2021).</li><li>Christiansen, I. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Characterization+of+lung+tumors+that+the+pulmonologist+can+biopsy+from+the+esophagus+with+endosonography+(EUS-B-FNA).">Characterization of lung tumors that the pulmonologist can biopsy from the esophagus with endosonography (EUS-B-FNA).</a> Respiration. 100 (2), 135-144 (2021).</li><li>Bibi, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+ultrasound-guided+pleural+biopsy+in+the+hands+of+the+pulmonologist.">Endoscopic ultrasound-guided pleural biopsy in the hands of the pulmonologist.</a> Respirol Case Rep. 8 (2), e00517 (2020).</li><li>Christiansen, I. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aspiration+of+pericardial+effusion+performed+with+EUS-B-FNA+in+suspected+lung+cancer.">Aspiration of pericardial effusion performed with EUS-B-FNA in suspected lung cancer.</a> Respiration. 99 (8), 686-689 (2020).</li><li>Christiansen, I. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EUS-B-FNA+for+diagnosing+liver+and+celiac+metastases+in+lung+cancer+patients.">EUS-B-FNA for diagnosing liver and celiac metastases in lung cancer patients.</a> Respiration. 98 (5), 428-433 (2019).</li><li>Issa, M. A., Sidhu, J. S., Tehrani, S. G., Clementsen, P. F., Bodtger, U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+ultrasound-guided+pancreas+biopsy+in+the+hands+of+a+chest+physician.">Endoscopic ultrasound-guided pancreas biopsy in the hands of a chest physician.</a> Respir Med Case Rep. 43, 101833 (2023).</li><li>Crombag, L. M. M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EUS-B-FNA+vs+conventional+EUS-FNA+for+left+adrenal+gland+analysis+in+lung+cancer+patients.">EUS-B-FNA vs conventional EUS-FNA for left adrenal gland analysis in lung cancer patients.</a> Lung Cancer. 108, 38-44 (2017).</li><li>Christiansen, I. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EUS-B+for+suspected+left+adrenal+metastasis+in+lung+cancer.">EUS-B for suspected left adrenal metastasis in lung cancer.</a> J Thorac Dis. 12 (3), 258-263 (2020).</li><li>Crombag, L. M. M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EUS-B-FNA+vs+conventional+EUS-FNA+for+left+adrenal+gland+analysis+in+lung+cancer+patients.">EUS-B-FNA vs conventional EUS-FNA for left adrenal gland analysis in lung cancer patients.</a> Lung Cancer. 108, 38-44 (2017).</li><li>Shen, Y., Qin, S., Jiang, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endobronchial+ultrasound-guided+transbronchial+needle+aspiration+combined+with+either+endoscopic+ultrasound-guided+fine-needle+aspiration+or+endoscopic+ultrasound+using+the+EBUS+scope-guided+fine-needle+aspiration+for+diagnosing+and+staging+mediastinal+diseases:+a+systematic+review+and+meta-analysis.">Endobronchial ultrasound-guided transbronchial needle aspiration combined with either endoscopic ultrasound-guided fine-needle aspiration or endoscopic ultrasound using the EBUS scope-guided fine-needle aspiration for diagnosing and staging mediastinal diseases: a systematic review and meta-analysis.</a> Clinics. 75, e1759 (2020).</li><li>Giri, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transesophageal+endoscopic+ultrasound-guided+tissue+acquisition+of+lung+masses:+a+case+series+with+systematic+review+and+meta-analysis.">Transesophageal endoscopic ultrasound-guided tissue acquisition of lung masses: a case series with systematic review and meta-analysis.</a> Ann Gastroenterol. 36 (2), 185-194 (2023).</li><li>Christiansen, I. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+and+feasibility+of+oesophageal+ultrasound+for+the+work-up+of+thoracic+malignancy+in+patients+with+respiratory+impairment.">Safety and feasibility of oesophageal ultrasound for the work-up of thoracic malignancy in patients with respiratory impairment.</a> J Thor Dis. , (2023).</li><li>Torii, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=EUS-B-FNA+enhances+the+diagnostic+yield+of+EBUS+bronchoscope+for+intrathoracic+lesions.">EUS-B-FNA enhances the diagnostic yield of EBUS bronchoscope for intrathoracic lesions.</a> Lung. 200 (5), 643-648 (2022).</li><li>Kang, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Infectious+complications+of+EBUS-TBNA:+A+nested+case-control+study+using+10-year+registry+data.">Infectious complications of EBUS-TBNA: A nested case-control study using 10-year registry data.</a> Lung Cancer. 161, 1-8 (2021).</li><li>Konge, L., Colella, S., Vilmann, P., Clementsen, P. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+to+learn+and+to+perform+endoscopic+ultrasound+and+endobronchial+ultrasound+for+lung+cancer+staging:+A+structured+guide+and+review.">How to learn and to perform endoscopic ultrasound and endobronchial ultrasound for lung cancer staging: A structured guide and review.</a> Endosc Ultrasound. 4 (1), 4-9 (2015).</li><li>Dhooria, S., Aggarwal, A. N., Gupta, D., Behera, D., Agarwal, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Utility+and+safety+of+endoscopic+ultrasound+with+bronchoscope-guided+fine-needle+aspiration+in+mediastinal+lymph+node+sampling:+Systematic+review+and+meta-analysis.">Utility and safety of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration in mediastinal lymph node sampling: Systematic review and meta-analysis.</a> Respir Care. 60 (7), 1040-1050 (2015).</li><li>Cot&#233;, G. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Training+in+EUS-guided+fine+needle+aspiration:+Safety+and+diagnostic+yield+of+attending+supervised,+trainee-directed+FNA+from+the+onset+of+training.">Training in EUS-guided fine needle aspiration: Safety and diagnostic yield of attending supervised, trainee-directed FNA from the onset of training.</a> Diagn Ther Endosc. 2011, 378540 (2011).</li><li>Meena, N., Hulett, C., Patolia, S., Bartter, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Exploration+under+the+dome:+Esophageal+ultrasound+with+the+ultrasound+bronchoscope+is+indispensible.">Exploration under the dome: Esophageal ultrasound with the ultrasound bronchoscope is indispensible.</a> Endosc Ultrasound. 5 (4), 254-257 (2016).</li><li>Nielsen, A. O., Cold, K. M., Vamadevan, A., Konge, L., Clementsen, P. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+endobronchial+ultrasound+-+The+six+landmarks+approach.">Systematic endobronchial ultrasound - The six landmarks approach.</a> J Vis Exp. (198), 65551 (2023).</li><li>Konge, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulator+training+for+endobronchial+ultrasound:+a+randomised+controlled+trial.">Simulator training for endobronchial ultrasound: a randomised controlled trial.</a> Eur Respir J. 46 (4), 1140-1149 (2015).</li><li>Naur, T. M. H., Konge, L., Nayahangan, L. J., Clementsen, P. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Training+and+certification+in+endobronchial+ultrasound-guided+transbronchial+needle+aspiration.">Training and certification in endobronchial ultrasound-guided transbronchial needle aspiration.</a> J Thorac Dis. 9 (7), 2118-2123 (2017).</li><li>Nayahangan, L. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Developing+a+simulation-based+training+curriculum+in+transesophageal+ultrasound+with+the+use+of+the+endobronchial+ultrasound-endoscope.">Developing a simulation-based training curriculum in transesophageal ultrasound with the use of the endobronchial ultrasound-endoscope.</a> Endosc Ultrasound. 11 (2), 104-111 (2022).</li><li>El Hajj, I. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+assessment+of+the+performance+of+a+new+fine+needle+biopsy+device+for+EUS-guided+sampling+of+solid+lesions.">Prospective assessment of the performance of a new fine needle biopsy device for EUS-guided sampling of solid lesions.</a> Clin Endosc. 51 (6), 576-583 (2018).</li><li>Adler, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+multicenter+evaluation+of+a+new+EUS+core+biopsy+needle:+Experience+in+200+patients.">A multicenter evaluation of a new EUS core biopsy needle: Experience in 200 patients.</a> Endosc Ultrasound. 8 (2), 99-104 (2019).</li><li>Balwan, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Core+needle+biopsy+with+endobronchial+ultrasonography:+single+center+experience+with+100+cases.">Core needle biopsy with endobronchial ultrasonography: single center experience with 100 cases.</a> J Am Soc Cytopathol. 9 (4), 249-253 (2020).</li><li>Mangiavillano, B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transesophageal+endoscopic+ultrasound+in+the+diagnosis+of+the+lung+masses:+a+multicenter+experience+with+fine-needle+aspiration+and+fine-needle+biopsy+needles.">Transesophageal endoscopic ultrasound in the diagnosis of the lung masses: a multicenter experience with fine-needle aspiration and fine-needle biopsy needles.</a> Eur J Gastroenterol Hepatol. 34 (7), 757-762 (2022).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>22 Gauge FNA needle system</td>
			<td>Olympus Medical Systems</td>
			<td>Vizishot</td>
			<td></td>
		</tr>
		<tr>
			<td>EBUS echoendoscope</td>
			<td>Olympus Medical Systems</td>
			<td>BF-UC190F</td>
			<td></td>
		</tr>
		<tr>
			<td>EVIS Exera II endoscopy tower with EVIS X1 video processor</td>
			<td>Olympus Medical Systems</td>
			<td>CV-1500&#160;</td>
			<td></td>
		</tr>
		<tr>
			<td>Lidocaine gel</td>
			<td>Multiple (e.g. Aspen Pharma)</td>
			<td>Xylocain 2%</td>
			<td></td>
		</tr>
		<tr>
			<td>Lidocaine spray</td>
			<td>Multiple (e.g. Aspen Pharma)</td>
			<td>Xylocaine Pump Spray</td>
			<td></td>
		</tr>
	</tbody>
</table>

using the endoscope for endobronchial ultrasound in the esophagus

Endoscopic ultrasound is a key procedure in the diagnosis and staging of lung cancer and allows safe sampling from mediastinal or hilar lymph nodes1,2. Endoscopic ultrasound comprises endobronchial (EBUS) and transesophageal ultrasound (EUS), are considered complementary procedures2.
Interventional pulmonologists are trained with the EBUS endoscope but are rarely familiar with the larger EUS endoscope (Figure 1), which requires special training to handle correctly3. EBUS and EUS are often performed by different departments and on separate sessions/days4. However, trained pulmonologists experienced with EBUS techniques can insert the smaller EBUS endoscope into the esophagus and perform safe examination and biopsy sampling from mediastinal lymph nodes and other lesions adjacent to the esophagus and stomach - a technique termed as EUS-B5. This leads to extension of pulmonologists&#39; ability to safely and conclusively sample lesions in many different anatomical sites such as lung6, pleura7, pericardial effusion8, mediastinal lymph nodes1,5, left liver lobe and retroperitoneal lymph nodes9, pancreas10 and the left adrenal gland11,12 (Figure 2).
The EUS-B procedure is a pulmonologist friendly version of the gastroenterologists&#180; EUS using an endoscope that the pulmonologist already masters. The EUS procedure is performed with a gastroendoscope which is both larger and heavier than the EBUS endoscope, has a different handle (with wheels, see Figure 1) and is unlike EBUS performed with the patient in left lateral decubitus. Learning EUS as a pulmonologist is challenging and requires a lot of training and supervision2.
EUS-B and EUS are so far very similar regarding diagnostic yield when performed in the field of pulmonology5,13,14,15. EUS-B is patient friendly since the endoscope is significantly thinner than that of EUS, and therefore less unpleasant for the pharynx and esophagus. Unlike EBUS, EUS-B does not cause direct airway irritation and is therefore safe to use in patients with suspected cancer resulting in severe respiratory impairment due to mediastinal tumor masses16.
The combination of EBUS and EUS-B is preferred over either test alone in any patient suspected of lung cancer, but EUS-B should especially be considered in patients with suspicious lesions out of reach by EBUS, but within range by transesophageal ultrasound (Figure 2). Adding EUS-B to EBUS in lung cancer work-up expands the interventional pulmonologists&#180; ability to perform diagnostic work-up during a single session using the same endoscope by one proceduralist, which is more convenient for the patient, saving both time and costs.
The complication risk of EUS-B is extremely low and is to our knowledge only limited to infectious complications17,18. EUS-B training should be easy and a natural continuation of EBUS, and the following protocol will describe how to perform EUS-B in mild sedation in an out-patient clinical setting.

<meta charset="utf8"></head><body>Autor em destaque: Técnicas avançadas de biópsia com ultrassom transesofágico

Usando o endoscópio para ultrassom endobrônquico no esôfago

Read this Scientific Article Protocol about Author Spotlight: Advancing Biopsy Techniques with Transesophageal Ultrasound at JoVE.com

EUS-B is a procedure using the echoendobronchoscope in the esophagus and stomach. The procedure is a minimally invasive, safe, and feasible approach that ...

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Research

JoVE Journal

Medicine

Using the Endoscope for Endobronchial Ultrasound in the Esophagus

249 visualizações.  Zealand University Hospital. Nosso escopo é identificar novas maneiras de realizar biópsias de áreas de difícil acesso da maneira mais amigável ao paciente. Assim, biópsias conclusivas com poucos eventos adversos, baixo desconforto dos pacientes e baixo custo. A EUS-B é uma técnica segura nas mãos de médicos respiratórios.Apesar de as biópsias não serem retiradas dos pulmões ou das vias aéreas, mas do esôfago ou estômago, isso permite uma investigação mais compl...

Vídeo: Autor em destaque: Técnicas avançadas de biópsia com ultrassom transesofágico

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.

Transesophageal ultrasound (EUS-B) is a safe and feasible procedure using the echoendobronchoscope (EBUS) in esophagus and stomach. After identifying six anatomical landmarks, additional structures can be identified and biopsied, sparing subsequent diagnostic sessions. Thus, EUS-B is an ideal continuation of bronchoscopy and EBUS in diagnosing lung cancer and other diseases.