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EBUS or bronchial echo-endoscopy

Principle

Echo-endoscopy or EBUS (for endobronchial ultrasound) is an exploration of the tracheal-bronchial tree, combining endoscopy with ultrasound. It reveals structures located behind the tree walls (mainly ganglions, tumours and cysts) and therefore not visible in a standard endoscopy. When the ultrasound is used as a guide, any problem areas discovered can be punctured in complete safety.
The principal indication is a diagnosis of invasion of the ganglions, a tumour, or certain benign conditions of the mediastinum, such as sarcoidosis or tuberculosis.

 

Technical details of the examination:

 

Preparation

- Examination conducted in outpatients’ department.
- Nil by mouth for 4 hours at least (nothing to eat, drink or smoke).
- Pre-medication (intravenously a few minutes before; midazolam and a medicine to dry up secretions) to reduce anxiety and coughing.
- Interruption of oral anticoagulants and Plaxix (replaced where necessary with subcutaneously administered anticoagulants, please consult doctor).
- Anaesthesia for mouth and back of throat (Xylocaine-based spray).
- Oxygen may be administered nasally throughout the examination, in order to prevent complications as far as possible. Levels of oxygen in the blood are also monitored continuously during the examination.
- In order to avoid any risk of the patient becoming infected with bacteria or viruses, all devices must be thoroughly cleaned and sterilised before being used.

Duration

- 20 minutes.
- One hour’s rest period in hospital immediately after examination (observation and disappearance of effects of sedation).

Contraindications

(the doctor carrying out the examination must be told if one of these applies to you)
- Stop taking aspirin or any other anticoagulant treatment at least 7 days before the examination (according to GP’s advice);
- Recently discovered coronary disease (angina pectoris);
- Recent heart attack;
- Chronic bronchitis or severe emphysema;
- Unstable bronchial asthma;
- Known blood coagulation problems.

Inconvenients

- It is not advisable to drive a vehicle on the same day.

Complications

- Nausea and coughing are normal (under local anaesthetic).
- Sputum with blood may be seen in the hours following the procedure if biopsies are carried out.
- Temperature may be raised, up to 39°, during the 12 hours after the procedure (treat with paracetamol). If the raised temperature lasts for more than 24 hours after the examination, a medical examination will be required (possible infection).

Complications (rare to very rare)

- In cases of sensitivity to local anaesthetic, severe complications, including cardiac arrest, may occur. (Literature describes 2 instances of death in over 50,000 bronchial endoscopies).
- Drastic reduction in blood pressure, cardiac arrhythmia, heart attack, fainting, convulsions, breathing difficulties, infections.

In cases of peripheral pulmonary biopsy:
- Pneumothorax, which may require admission to hospital.
- Severe haemorrhage has been reported, but is exceptional.

 

What should be done if complications occur?: If complications occur, post-examination observation will be extended and admission to hospital may be necessary. Cardiac problems or severe vagal problems may require the administration of drugs. If haemorrhage occurs, a coagulant substance may be administered in the bronchus.

 

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