Inside you airways

Innovative uses of conventional technologies have resulted in newer applications in health care. Endobronchial Ultrasound is one such application. Ultrasonography (USG) for medical diagnostic purpose began around 1950s and has found wider utility since. Trans-abdominal ultrasound is used extensively in antenatal care, urology, emergency medicine and gastroenterology. Advances in technology have resulted in miniaturisation of the USG probe. Attaching this probe to a bronchoscope, an instrument used to view inside the airways of lungs, allows trans-bronchial ultrasound scan also called endobronchial ultrasound or (EBUS).

What is Endobronchial Ultrasound?

Endobronchial Ultrasound is a newer diagnostic modality useful in the evaluation of mediastinal pathology. Endobronchial ultrasound scope is similar to the conventional bronchoscope but has an ultrasound probe at the tip. While the view through bronchoscope is limited to endobronchial mucosa, EBUS enables the operator to view structures beyond the mucosa; the airway wall, mediastinal nodes, the organs and vessels of the thorax.

What are the indications for EBUS?

Obtaining tissue diagnosis for any mediastinal pathology; Staging of lung cancer; Obtaining core tissue from highly vascular airway lesions; Assessing the extent of tumour infiltration into the bronchial wall; Obtaining tissue from peripheral intrapulmonary lesions; Deciding on the modality of management in central airway stenosis.

How long does the procedure take?

Generally EBUS lasts less than 30 minutes. To enhance patient and operator comfort, short general anaesthesia may be used. Patients should remain nil oral for 6-8 hours pre-procedure. Drugs that cause excessive bleeding like clopidogrel should be stopped at least a week before. Aspirin has not been shown to significantly increase the risk of bleeding. Patients can leave the hospital 4-5 hours after the procedure.

What are the possible complications of EBUS-guided Trans Bronchial Needle Aspiration (TBNA)?

It is a relatively safe procedure without any side-effects.

How does EBUS-TBNA compare with PET for assessing mediastinal node secondaries?

Since tissue diagnosis is not obtainable in PET, its scope is limited.

What are the future possibilities with the EBUS?

EBUS has been so far used primarily as a diagnostic modality and attempts are being made to explore its use as a therapeutic tool. EBUS-guided draining of bronchogenic cysts in patients unfit for open thoracotomy has been reported.

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this article is from the Hindu paper