EBUS-TIPNA can be done as a safe and successful procedure and adds to the armamentarium of Convex Probe-EBUS (CP-EBUS), in carefully selected patients.

Background Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) provides a high diagnostic yield in lung cancer, but the yield for benign conditions and lymphoma is lower. The material obtained by EBUS‐TBNA is limited by the lack of histopathological samples in some cases. The current ‘expanded’ aims of mediastinal lymph node (MLN) sampling are both an accurate diagnosis and adequate material for ‘targeted’ processing in malignant and benign disease. The sample obtained with the 21/22G EBUS needle may not be sufficient in all situations. Objectives The aim of the study was to evaluate the role of a novel technique for EBUS‐guided MLN forceps biopsy (EBUS‐TBFB) when EBUS‐TBNA with rapid on‐site‐evaluation (ROSE) failed to provide a diagnosis. In addition, the technical aspects and safety of EBUS‐TBFB were studied. Methods About 30 consecutive patients with enlarged MLN, with a negative EBUS‐TBNA ROSE were included. EBUS‐TBFB was done by the method described below. The histopathology and complications were recorded. Results Adequate samples for analysis were obtained in all the patients with both EBUS‐TBNA and EBUS‐TBFB. In patients with a non‐diagnostic EBUS‐ROSE, EBUS‐TBFB led to positive diagnostic results in an additional 8/30 patients (27%). Mild bleeding was noted in two patients who underwent EBUS‐TBFB, which resolved with conservative management. The procedure was safe with no major complications. Conclusion In patients with a negative EBUS‐ROSE, EBUS‐TBFB using this technique is safe and augments the diagnostic yield. EBUS‐TBFB adds to the armamentarium of EBUS, especially in benign aetiologies of MLN enlargement.

Background: The incidence of caudal stent migration in high tracheal stenting is 13-21% and is common with silicone stents. This can lead to major problems, including emergency repeat procedures. Several antimigration methods are described, but have limitations in terms of their success rate, availability, cost or ease of the procedure. Objectives: We describe an innovative method of stent migration prevention using a simple percutaneous anchoring “hitch stitch”, validated in a large series. Methods: After tracheal stent placement, an Ethilon suture was passed into the stent lumen through an 18-G needle. To take this suture back to the exterior to complete the stitch, a retrieval loop was passed through another 14-G percutaneous cannula inserted into the stent lumen. Bronchoscopically, using a forceps the first suture was pulled inside the loop, the loop was retracted, the suture was exteriorized, and the knot was completed and embedded subcutaneously. While removing the stent, an endoscopic scissor was used to cut the stitch to free the stent. Results: A total of 42 “hitch stitches” were done in 29 patients over 5 years, predominantly for silicone stents. Indications for stenting included postintubation tracheal stenosis (83.3%), malignancy (11.9%) and tracheoesophageal fistula (4.8%, metal stents). The procedure was successful in 41/42 (97.6%) patients. Stitch removal was uncomplicated. Conclusion: This is the largest series of an external stent anchoring procedure as a migration prevention strategy in high tracheal stenting, applicable to both silicone and metal stents. Stent migration prevention using this “hitch stitch” is simple, safe and successful, without any complications during stent removal.

CESBs represent a safe, effective, and innovative approach in the management of PAL. They should be considered in patients who are not surgical candidates, fail surgery, or those who have a recurrence following surgery.

Neisseria cinerea is a commensal bacteria of the human oropharynx, not thought to be pathogenic, and is rarely associated with serious infections, including bacteremia. Case reports involving invasive N. cinerea infections are uncommon in the literature. Retropharyngeal abscesses are unusual in adults, and are usually attributable to local trauma. Based on a review of the literature, Neisseria cinerea bacteremia secondary to a retropharyngeal abscess has not been described. We present a unique case of an elderly female without clear predisposing factors for a retropharyngeal abscess, who presented with a N. cinerea bacteremia and was found to have an asymptomatic retropharyngeal abscess.