Complications of Convex-Probe Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Multi-Center Retrospective Study

Abstract

BACKGROUND: Infrequent serious complications of convex-probe endobronchial ultrasoundguided transbronchial needle aspiration (EBUS-TBNA) have been reported. The aim of this study was to assess serious complications related to convex-probe EBUS-TBNA and to determine the complication rate in a large group of subjects. METHODS: In this retrospective study, a 15-item questionnaire on features of cases with EBUS-TBNA complications was sent to experienced bronchoscopists performing convex-probe EBUS-TBNA at 3 pulmonary centers. The medical records were then reviewed by these bronchoscopists to complete the questionnaire. Hemorrhage responsive to topical treatment, temporary laryngospasm/bronchospasm, transient oxygen desaturation, and fever lasting <24 h were excluded. Only complications requiring further treatment/intervention were considered serious. The rate of serious complications was calculated from the obtained data. RESULTS: In a total of 3,123 cases within a 5-y period, EBUS-TBNA was performed for staging lung cancer in 15.8%, diagnosis in 67.5%, and diagnosis and staging in 16.3%. Of the 3,123, 11.6% had parenchymal lesions adjacent to major airways. EBUS-TBNA was performed 11,753 times (3.76/case) at 6,115 lymph node stations and lesions (1.92/station or lesion). Five serious complications were recorded (0.16%): fever lasting >24 h, infection of bronchogenic cyst, mediastinal abscess, pericarditis, and pneumomediastinitis with empyema, each in one case. Four complications occurred in cases diagnosed with benign disease by EBUS-TBNA. All complications were treated with broad-spectrum antibiotics. Four subjects were hospitalized for 21.7 ؎ 20.7 d. CONCLUSIONS: Convex-probe EBUS-TBNA is a safe method in general. However, serious complications, including infections, can be encountered rarely. All precautions should be taken for complications before and during the procedure.

Incidence of Fever Following Endobronchial Ultrasound–Guided Transbronchial Needle Aspiration

“…According to a Japanese nationwide survey, the infectious complication rate of EBUS-TBNA was 0.19%4. A recent study of 3,123 cases undergoing the procedure reported infectious complications in 0.16%5. Serious complications such as mediastinal abscess, pneumomediastinum, empyema, pericarditis, sepsis, and intramural hematoma have been described in case reports678.…”

Efficacy of Antibiotic Prophylaxis after Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: A Preliminary Prospective Study

“…However, the puncture of LNs with low-density areas did not elevate the frequency of postbronchoscopy fever in this study. The risk of infectious complications after puncturing a cystic lesion was demonstrated in a past report [31]. Patient selection, thus, could be more important in preventing infectious adverse events.…”

“…One of secondary outcome was preventive effect of serious infectious complications by prophylactic antibiotics in this preliminary study, and those kind of infectious events did not occur. Recent large multicenter-retrospective studies have shown that serious infectious complications after EBUS-TBNA are very rare (0.16%-0.19%) [15,31]. It was unclear whether prophylactic antibiotics had been used to treat patients in past reviews; nevertheless, precautions against such rare complications may be unnecessary.…”

Diagnostic Yield of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for Sarcoidosis

“…However, three studies reported having observed agitation, cough, and presence of blood at the puncture site (12). In another retrospective study analyzing 3123 patients undergoing EBUS, the complication rate was found to be low at 0.16% that included pneumomediastinum with empyema, mediastinal abscess, fever lasting longer than 24 h, infection of a bronchogenic cyst, and pericarditis (7). These data suggest that EBUS-TBNA is a safe procedure when compared to mediastinoscopy, with an associated morbidity rate of 1% and mortality rate of 0.05%, or VATS, with an associated morbidity rate of 4% and mortality rate of 2% (8,32).…”

“…When evaluating mediastinal lymphadenopathy for sarcoidosis, potential diagnostic tools include mediastinoscopy and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) (7). Though mediastinoscopy is the gold standard for evaluating mediastinal lymphadenopathy of unknown etiology, it requires general anesthesia and has associated risks including recurrent laryngeal nerve injury, bleeding, and tracheal injury (8).…”