Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (e.g., aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node assessment.

Summary

A bronchoscopy with endobronchial ultrasound (EBUS) is a diagnostic procedure that uses a thin, flexible, or rigid tube to look inside the lungs and air passages. It often includes imaging guidance and needle sampling of lymph nodes in the chest to diagnose or stage lung diseases, particularly cancer.

Purpose

The procedure helps in diagnosing lung conditions, such as infections, inflammation, or cancer. It can also stage lung cancer by determining if cancer has spread to the lymph nodes. The goal is to obtain tissue samples in a minimally invasive way for accurate diagnosis and treatment planning.

Indications

• Persistent cough or unexplained cough
• Abnormal chest X-ray or CT scan
• Suspected lung cancer or lung infections
• Evaluation of lymphadenopathy (enlarged lymph nodes)
• Assessment of known cancer spread to lymph nodes

Preparation

• Patients are usually advised to fast for several hours before the procedure.
• Certain medications, particularly blood thinners, may need to be adjusted or stopped prior to the procedure.
• Pre-procedure assessments often include basic blood work and imaging studies.

Procedure Description

1. The patient is given sedation or general anesthesia.
2. A bronchoscope is inserted through the mouth or nose into the windpipe and lungs.
3. Endobronchial ultrasound (EBUS) is used to visualize lymph nodes and surrounding structures.
4. Fluoroscopic guidance may assist in precisely targeting the area for sampling.
5. A fine needle is used to aspirate or biopsy lymph nodes via transtracheal or transbronchial routes.
6. Samples are sent to the lab for analysis.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is commonly performed in a hospital, outpatient clinic, or specialized surgical center.

Personnel

• Pulmonologist or thoracic surgeon
• Nurse or respiratory therapist
• Anesthesiologist (if general anesthesia is used)

Risks and Complications

• Common risks: Mild bleeding, infection, sore throat, or discomfort at the sampling site.
• Rare risks: Significant bleeding, lung puncture (pneumothorax), adverse reaction to anesthesia, or complications from the sedation.

Benefits

• Provides valuable diagnostic information with a minimally invasive approach.
• Allows for accurate staging of lung cancer.
• Aids in determining appropriate treatment strategies quickly, often with minimal discomfort.

Recovery

• Patients are typically observed for a few hours post-procedure to monitor for complications.
• Mild sore throat or coughing is common but usually resolves within a few days.
• Most patients return to normal activities within 24 hours, unless advised otherwise by their doctor.
• Follow-up appointments may be scheduled to discuss results and next steps.

Alternatives

• CT-guided biopsy: An external needle biopsy using CT imaging—less invasive but sometimes less accurate.
• Surgical biopsy: More invasive and often requires anesthesia; used if other methods aren’t conclusive.
• Observation and follow-up imaging: Non-invasive but may delay diagnosis and treatment.

Patient Experience

Patients may experience mild discomfort and a sore throat after the procedure. Pain management and comfort measures include throat lozenges, over-the-counter pain relievers, and rest. Any significant pain or symptoms should be reported to a healthcare provider immediately.