Safety and accuracy of the nasal route for linear endobronchial ultrasound

Background Linear endobronchial ultrasound (EBUS) is a safe and accurate diagnostic test for mediastinal adenopathy. Its feasibility through the nasal route has not been reported. Objective To document the feasibility of linear EBUS using the nasal route and compare its accuracy and safety with the oral route. Methods A retrospective analysis of consecutive subjects who underwent an EBUS procedure under conscious sedation at our center was conducted. Nasal insertion of the fibroscope was attempted in all subjects; the oral route was used in case of failure of nasal insertion. Characteristics of the procedure and the diagnostic accuracy of EBUS were compared between the two insertion routes. Results From May to October 2012, 209 subjects underwent an EBUS. Complete data was available for 196 subjects. Nasal insertion of the EBUS fibroscope was possible in 73.5%. There was no difference between the two insertion routes in the location and number of stations sampled per subject. Procedure duration and doses of local anesthetic were similar. Complications (epistaxis, bronchial bleeding, desaturation, pneumothorax) were similar between the two groups (2.1% in the nasal group vs 1.9% in the oral group). Minor epistaxis occurred in only one subject in the nasal group. Comparing the nasal and oral groups, rates of adequate specimens were comparable (90.5 vs 88.9%, respectively; p=0.68), and proportions of diagnostic specimens were not statistically different (51.4% vs 42.3%, respectively; p=0.26). Conclusion Linear EBUS can be performed safely via the nasal route and with comparable accuracy to the oral route. Controlled studies are required to determine which insertion route provides best patient comfort.