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Advanced, Interventional Procedure of EBUS- Dr Nishtha Singh

Good afternoon everyone, my task today is to teach you, guide you, assist you, and make you understand this advanced, interventional procedure, EBUS. So as Mark Twain said, "The secret of getting ahead is getting started." Let's get started

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Advanced, Interventional Procedure of EBUS- Dr Nishtha Singh

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  1. Endo-bronchial ultrasoundBronchoscopy (EBUS) Dr Nishtha Singh Executive Director & Senior Pulmonary Consultant Asthma Bhawan, Jaipur Dr Nishtha Singh

  2. 30Y EBUS Timeline 1992: Radial EBUS 2003: Convex probe EBUS 2008: EBUS in India 2016: First EBUS in Rajasthan at Asthma Bhawan First publication in 2003 & first guidelines in 2013 to recommend EBUS as first line test for lung cancer

  3. Conventional TBNA EBUS-TBNA Point : Should EBUS Guide Every Transbronchial Needle Aspiration of Mediastinal Lymph Nodes? Dr Nishtha Singh

  4. Can we drive our cars on the road with headlights off at night? Conventional TBNA is like driving blindly. Dr Nishtha Singh

  5. Sample by conventional TBNA Sample by EBUS Dr Nishtha Singh

  6. Point Should Endobronchial Ultrasound Guide Every Transbronchial Needle Aspiration of Lymph Nodes? Yes Dr Nishtha Singh

  7. Indications • Mediastinal masses • Mediastinal LN of unclear etiology • Diagnosis of NSCLC • Negative conventional TBNA • Staging of NSCLC Dr Nishtha Singh

  8. Contraindications Absolute Contraindications • Absent informed consent • Severe refractory hypoxia • Uncorrectable severe bleeding diathesis • Malfunctioning equipment Relative Contraindications • Life-threatening cardiac arrhythmias- in past 6wks • Current or recent MI- in past 6wks • Respiratory insufficiency or failure- in past 6wks • Uncontrolled hypertension • Poorly controlled heart failure • Uncooperative patient Dr Nishtha Singh

  9. Contraindications Related to bleeding risk 1. Current anti-platelet agents- Stop 4-5d prior to procedure 2. INR≥1.3 or APTT>1.5 times N 3. Current anticoagulant therapy- Stop prior to procedure • LMWH in past 24h • Warfarin for 3-5 d • Clopidogrel for 5-7d 4. Coagulopathy 5. Thrombocytopenia- platelet count<50000/microL 6. Elevated blood urea nitrogen or serum creatinine Dr Nishtha Singh

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