Management Team

Endobronchial Ultrasound (EBUS)

Overview

EBUS is a technique that uses ultrasound along with a bronchoscope to visualise the airway wall and structures adjacent to it.

  • Radial Probe EBUS
    This system has an ultrasound processor and balloon catheter attached to the probe. The balloon is fixed at the tip of the probe. It helps take biopsies from the peripheral parts of the lung, which are otherwise not accessible by routine flexible bronchoscopy.
  • Convex Probe EBUS
    In contrast to the radial probe, convex probe has the advantage of accessing central lesions that are in or adjacent to the lung (mediastinum). High-resolution, real-time ultrasound imaging enables direct visualisation of the needle as it penetrates the lymph node, which optimises the biopsy sample and makes the procedure relatively safe.

  • Assess the extent of airway invasion: EBUS has extended vision beyond the tracheobronchial wall. With EBUS, the delicate multilayer structure of the tracheobronchial wall can be analysed. This knowledge becomes decisive for the management of early cancer in the central airways.
  • Peripheral intrapulmonary lesions: Radial probe EBUS can be used to localise peripheral pulmonary nodules and sampling of the lesion can be done without fluoroscopy.
  • Analysis of mediastinal lesions: Assessment of mediastinal lymph nodes is important for lung cancer staging and planning appropriate treatment strategy. Once target lymph node is identified, linear probe EBUS allows real-time ultrasound guidance during needle insertion. EndoBronchial UltraSound-Guided TransBronchial Needle Aspiration (EBUS-TBNA) can be used in the evaluation of mediastinal adenopathy due to other aetiologies like sarcoidosis and tuberculosis.
  • Guidance of endobronchial therapy: EBUS provides useful additional information during various interventions, including resection of endobronchial lesions, stricture dilatation, airway stenting, laser therapy and argon plasma coagulation.

  • Life-threatening cardiac arrhythmias
  • Current or recent myocardial ischaemia
  • Poorly controlled heart failure
  • Severe hypoxemia
  • Uncooperative patient

Additional contraindications to EBUS-TBNA are related to bleeding risk and include following:

  • Current anti-platelet agents, such as Ecosprin and Clopidogrel
  • Current anticoagulant therapy, such as warfarin
  • Coagulopathy
  • Thrombocytopenia
  • Elevated blood urea nitrogen or serum creatinine levels

EBUS and EBUS-TBNA are usually safe. Some complications are agitation, cough, hypoxia, laryngeal injury, fever, bacteraemia and infection, bleeding, pneumothorax and broken equipment being stuck in the airway.

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