Background: Endosonography [endoscopic ultrasound (EUS)-guided fine needle aspiration and endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration] is increasingly used for lung cancer staging and the assessment of sarcoidosis. Serious adverse events (SAE) have been reported in case reports, but the true incidence of complications is yet unknown. Objectives: To assess the rate of SAE related to endosonography and to investigate associated risk factors. Materials and Methods: PubMed, EMBASE and Cochrane libraries were searched for eligible references up to April 2012 and these included studies reporting on linear EUS or EBUS for the analysis of mediastinal/hilar nodal or central intrapulmonary lesions. Case series describing complications were excluded. Reported complications were classified into SAE or minor adverse events (AE). Results: 190 studies met the inclusion criteria. Information on follow-up was missing in half of the studies. In 16,181 patients, 23 SAE (0.14%) and 35 AE (0.22%) were reported. No mortality was observed. SAE were more frequent in patients investigated with EUS (0.30%) than in those investigated with EBUS (0.05%). Infectious SAE were most prevalent (0.07%) and predominantly occurred in patients with cystic lesions and sarcoidosis. In lung cancer patients, complications were rare. Discussion: Endosonography for intrathoracic nodal assessment seems safe for lung cancer patients and mortality has not been reported. For cystic lesions and sarcoidosis, there may be a small, but nonnegligible risk of infectious complications. The true incidence of SAE might be higher as accurate documentation of complications is missing in most studies.

Silvestri GA, et al: Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013;143(suppl 5):e211S-e250S.
Vansteenkiste J, et al: Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013;24(suppl 6):vi89-vi98.
Tremblay A, et al: A randomized controlled trial of standard vs endobronchial ultrasonography-guided transbronchial needle aspiration in patients with suspected sarcoidosis. Chest 2009;136:340-346.
von Bartheld MB, et al: Endosonography versus conventional bronchoscopy for the diagnosis of sarcoidosis: the GRANULOMA randomized clinical trial. JAMA 2013;309:2457-2464.
Aerts JG, et al: EUS-FNA of enlarged necrotic lymph nodes may cause infectious mediastinitis. J Thorac Oncol 2008;3:1191-1193.
Gamrekeli A, et al: Infection of a bronchogenic cyst after ultrasonography-guided fine needle aspiration. Ann Thorac Surg 2013;95:2154-2155.
Huang CT, et al: A rare constellation of empyema, lung abscess, and mediastinal abscess as a complication of endobronchial ultrasound-guided transbronchial needle aspiration. Eur J Cardiothorac Surg 2011;40:264-265.
Moffatt-Bruce SD, Ross P Jr: Mediastinal abscess after endobronchial ultrasound with transbronchial needle aspiration: a case report. J Cardiothorac Surg 2010;5:33.
von Bartheld M, van der Heijden E, Annema J: Mediastinal abscess formation after EUS-guided FNA: are patients with sarcoidosis at increased risk? Gastrointest Endosc 2012;75:1104-1107.
Wildi SM, et al: Diagnosis of benign cysts of the mediastinum: the role and risks of EUS and FNA. Gastrointest Endosc 2003;58:362-368.
Zhang R, et al: Combined endobronchial and endoscopic ultrasound-guided fine needle aspiration for mediastinal lymph node staging of lung cancer: a meta-analysis. Eur J Cancer 2013;49:1860-1867.
Chandra S, et al: Diagnostic accuracy of endobronchial ultrasound-guided transbronchial needle biopsy in mediastinal lymphadenopathy: a systematic review and meta-analysis. Respir Care 2012;57:384-391.
Micames CG, et al: Endoscopic ultrasound-guided fine-needle aspiration for non-small cell lung cancer staging: a systematic review and metaanalysis. Chest 2007;131:539-548.
Tournoy KG, et al: EBUS-TBNA for the diagnosis of central parenchymal lung lesions not visible at routine bronchoscopy. Lung Cancer 2009;63:45-49.
Asano F, et al: Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res 2013;14:50.
Chirica M, et al: Esophageal perforations. J Visc Surg 2010;147:e117-e128.
Hirdes MM, et al: Performance of EUS-FNA for mediastinal lymphadenopathy: impact on patient management and costs in low-volume EUS centers. Surg Endosc 2010;24:2260-2267.
Peric R, et al: Transesophageal endoscopic ultrasound-guided fine-needle aspiration for the mediastinal staging of extrathoracic tumors: a new perspective. Ann Oncol 2010;21:1468-1471.
Lee YT, et al: Endoscopic ultrasonography-guided fine-needle aspiration in the management of mediastinal diseases: local experience of a novel investigation. Hong Kong Med J 2010;16:121-125.
Varadarajulu S, et al: Comparison of EUS-guided 19-gauge Trucut needle biopsy with EUS-guided fine-needle aspiration. Endoscopy 2004;36:397-401.
Bournet B, et al: Early morbidity of endoscopic ultrasound: 13 years' experience at a referral center. Endoscopy 2006;38:349-354.
Iwashita T, et al: The yield of endoscopic ultrasound-guided fine needle aspiration for histological diagnosis in patients suspected of stage I sarcoidosis. Endoscopy 2008;40:400-405.
von Bartheld MB, et al: Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of sarcoidosis. Endoscopy 2010;42:213-217.
Aithal GP, et al: EUS-guided tissue sampling: comparison of ‘dual sampling' (Trucut biopsy plus FNA) with ‘sequential sampling' (Trucut biopsy and then FNA as required). Endoscopy 2007;39:725-730.
Hernandez A, et al: EUS-FNA as the initial diagnostic modality in centrally located primary lung cancers. J Clin Gastroenterol 2007;41:657-660.
Tournoy KG, et al: Transesophageal endoscopic ultrasound with fine needle aspiration in the preoperative staging of malignant pleural mesothelioma. Clin Cancer Res 2008;14:6259-6263.
Annema JT, et al: Implementation of endoscopic ultrasound for lung cancer staging. Gastrointest Endosc 2010;71:64-70, 70 e1.
Yasuda I, et al: Mediastinal lymph node staging in potentially resectable non-small cell lung cancer: a prospective comparison of CT and EUS/EUS-FNA. Respiration 2009;78:423-431.
Storch I, et al: Endoscopic ultrasound-guided fine-needle aspiration and Trucut biopsy in thoracic lesions: when tissue is the issue. Surg Endosc 2008;22:86-90.
Nayar DS, et al: Comparison of propofol deep sedation versus moderate sedation during endosonography. Dig Dis Sci 2010;55:2537-2544.
Eloubeidi MA, Tamhane A: Prospective assessment of diagnostic utility and complications of endoscopic ultrasound-guided fine needle aspiration. Results from a newly developed academic endoscopic ultrasound program. Dig Dis 2008;26:356-363.
Hwangbo B, et al: Transbronchial and transesophageal fine-needle aspiration using an ultrasound bronchoscope in mediastinal staging of potentially operable lung cancer. Chest 2010;138:795-802.
Navani N, et al: Utility of endobronchial ultrasound-guided transbronchial needle aspiration in patients with tuberculous intrathoracic lymphadenopathy: a multicentre study. Thorax 2011;66:889-893.
Bauwens O, et al: Endobronchial ultrasound and value of PET for prediction of pathological results of mediastinal hot spots in lung cancer patients. Lung Cancer 2008;61:356-361.
Annema JT, et al: Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial. JAMA 2010;304:2245-2252.
Garwood S, et al: Endobronchial ultrasound for the diagnosis of pulmonary sarcoidosis. Chest 2007;132:1298-1304.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.