Endobronchial ultrasound or ebus

Endobronchial ultrasound (EBUS) is an exploration of the tracheobronchial tree that combines endoscopy and ultrasound.

This examination allows for the visualization of the structures located behind the walls (mainly lymph nodes, tumors, and cysts) and not visible in conventional endoscopies. Under ultrasound guidance, the anomalies discovered can then be safely punctured. The main indications are the diagnosis of lymph node invasion, the diagnosis of a tumor per se, or the diagnosis of certain benign pathologies of the mediastinum, such as sarcoidosis or tuberculosis.

The exam lasts about 20 minutes.

You must stop drinking, eating, and smoking for at least 4 hours before the examination, which is performed on an outpatient basis. It will also be necessary to stop taking oral anticoagulants and Plavix®. If necessary, these can be replaced by subcutaneous injections of anticoagulants, in agreement with the doctor.

To calm anxiety and coughing, a premedication is administered intravenously a few minutes before the examination. This premedication is midazolam, a drug that dries up secretions. The mouth and back of the throat are anesthetized with a xylocaine-based spray.

Oxygen can be administered nasally during the entire examination to prevent complications as much as possible. Oxygen quantity in the blood is continuously monitored during the examination as well.

In order to avoid any risk of contamination of the patient by microbes or viruses, the devices are carefully cleaned and sterilized between each use.

Resting for one hour in the hospital is necessary immediately after the examination to enable monitoring and dissipation of the effects of sedation.

Following local anesthesia, nausea and coughing are common. If biopsies are performed, a small amount of bleeding can manifest itself in the form of bloody sputum in the hours following the procedure.

High temperature, up to 39°, may occur within 12 hours after the procedure and should be treated with aspirin or paracetamol. A medical examination is necessary if the fever persists more than 24 hours after the examination.

If there is a sensitivity to the local anesthetic, severe complications are possible; including cardiac arrest, (two cases of death have been described in the literature out of over 50,000 bronchial endoscopies).

Severe blood pressure drops, cardiac arrhythmias, myocardial infarction, syncope, convulsions, breathing difficulties, and infections are rare to very rare complications.

In case of peripheral lung biopsies, pneumothorax may occur and require a hospital stay. Severe bleeding has been reported only exceptionally.

What happens if there are complications?

In case of complications, post-examination monitoring is prolonged and hospitalization may be necessary. Cardiac problems and severe vagal reactions may require medication. A clotting agent can be applied to the bronchus in case of bleeding.

Aspirin or any anticoagulant treatment must be stopped at least 7 days before the examination, according to the advice of the attending physician.

The doctor who performs the examination must be informed if you have any of the following conditions: new-onset coronary artery disease (angina), recent myocardial infarction, chronic bronchitis or severe emphysema, unstable bronchial asthma, and known blood clotting disorders.

Driving a vehicle the same day is not advised.