HJNO Jul/Aug 2019

Healthcare Journal of new orleans I  JUL / AUG 2019 47 Brian J. Parker, MD Pulmonologist and Critical Care Specialist Thibodaux Regional Medical Center past, bronchoscopy has been somewhat limited in its ability to assist with staging. With the development of EBUS, that has changed. EBUS is a bronchoscopic technique that utilizes ultrasound to visualize ana- tomical structures outside of the airways. A primary advantage is its ability to visu- alize lymph nodes that are located in the mediastinum just outside of the airway walls. Once visualized, these lymph nodes can be sampled with a very small needle to identify any areas of cancer involvement. Prior to the advent of EBUS, most of these lymph nodes could not be safely evaluated with standard bronchoscopic techniques. Many times a second surgical procedure, called mediastinoscopy, would need to be performed as well. In most cases, EBUS has obviated the need for another surgical intervention. Given that bronchoscopy with EBUS is both a diagnostic and staging procedure, patients can generally be evaluated by on- cologists in a timelier manner. This, in turn, results in less delay with regards to initi- ating treatment. The lymph node samples are usually adequate to perform special stains that aid in the process of deciding the most appropriate treatment regimen. As the use of EBUS bronchoscopy has be- come more routine, it has been used more to diagnose other malignant conditions, such as lymphoma, and nonmalignant conditions, such as sarcoidosis and certain infections. Another benefit of EBUS bronchoscopy is that it is an outpatient procedure that does not require hospitalization. It is a gen- erally safe procedure with the same risk profile as standard bronchoscopy. Primary risks are related to bleeding and the small risk of pneumothorax (area of collapsed lung). If a patient is on anticoagulant or an- tiplatelet medications, your physician may hold these temporarily prior to the pro- cedure. Again, these risks are small. EBUS bronchoscopy is generally performed un- der moderate sedation or general anesthe- sia, depending upon the experience and preference of your physician. Depending upon how many areas require sampling, the procedure generally takes between 45 and 90 minutes. Recovery time is minimal. Patients can frequently leave the facility within an hour of completing the proce- dure. Post-procedure monitoring is most- ly related to the clearance of medications used for sedation. There are generally no restrictions following EBUS bronchoscopy, and most of the time, patients are back to normal activity the next day. Once treatment is initiated, oncologists may perform surveillance studies with computed tomography (CT) or PET im- aging to assess response to therapy or to evaluate for progression of disease. EBUS bronchoscopy at times will be performed if there is a question of disease progression not clearly answered by imaging. In conclusion, as novel methods are identified for early detection and treat- ment, it is important that better approach- es are pursued with regards to the diagno- sis and staging of lung cancer. Reducing the number of invasive procedures, and identifying methods that are low risk to patients, are ways to accomplish this. Bronchoscopy with the use of endobron- chial ultrasound is an exciting step in that direction. n Brian J. Parker, MD, Pulmonologist/Critical Care Specialist, earned an undergraduate degree in biomedical engineering, summa cum laude, from Louisiana Tech University in Ruston. He received a medical degree from Louisiana State University Health Sciences Center in Shreveport and complet- ed a residency in internal medicine at Ochsner Clin- ic Foundation in New Orleans, where he also served as chief resident.Additionally, Dr. Parker completed a fellowship in pulmonary and critical care medi- cine at Louisiana State University Health Sciences Center in New Orleans. Dr. Parker is board certified in internal medicine and pulmonary disease by the American Board of Internal Medicine. “EBUS is a bronchoscopic technique that utilizes ultrasound to visualize anatomical structures outside of the airways. A primary advantage is its ability to visualize lymph nodes that are located in the mediastinum just outside of the airway walls.”