Bronchoscopy with EBUS-TBNA

Bronchoscopy involves placing a thin tube-like instrument called a bronchoscope through the nose or mouth and down into the airways of the lungs. The tube has a mini-camera at its tip and is able to carry pictures back to a video screen or camera.

In EBUS-TBNA, a specially designed bronchoscope with an ultrasound probe at its tip is introduced within the tracheobronchial tree, and the target lesion—usually a lymph node—is outlined first. Next, an EBUS-TBNA needle is introduced via the working channel of the bronchoscope, and under direct ultrasound imaging, a sample is collected from the target lymph node for lab investigations.

The radial probe EBUS is a thin probe passed through the working channel of a conventional bronchoscope to localize peripheral lesions, which then can be sampled and biopsied using forceps or a cryoprobe.

Possible Risks and Complications

Every effort will be made to conduct the procedure in such a way as to minimize discomfort and risks. However, just as with other procedures, there are inherent potential risks. The incidence of major complications associated with bronchoscopy is 0.8%–1.3%. These may include:

• Accumulation of air in pleural space
• Hemorrhage
• Subcutaneous emphysema
• Postoperative fever
• Chest infection
• Cardiac arrhythmias
• Hypoxemia
• Vasovagal attack
• Myocardial infarction
• Pulmonary edema
• Bronchospasm
• Choking
• Perforation of airway
• Tracheo-esophageal fistula

Systematic reviews report only one incidence of morbidity (0.07%) due to pneumothorax, and the mortality rate associated with bronchoscopy is less than 0.01%.

Post Procedure Course

• Postoperative oxygen supplementation may be required, particularly for those with impaired lung function or those who have been sedated.
• A chest radiograph is carried out post-procedure (where indicated).
• Patients who have had transbronchial biopsies should observe for symptoms like chest pain, breathlessness, haemoptysis, surgical emphysema, or excessive cough, and contact emergency if these occur.
• Sedated patients are advised not to drive, sign legal documents, or operate machinery for 24 hours.
• Day-care patients who have been sedated should be accompanied home, and high-risk individuals (elderly or biopsy patients) should have someone stay with them overnight.