Feasibility and patient satisfaction with transnasal diagnostic EUS-b under conscious sedation

Abstract

Introduction: EUS-b is a safe procedure, complementary of EBUS for mediastinal staging of lung cancer. By reaching otherwise inaccessible locations, it may be useful as a diagnostic exam. There are no available data on the ideal route of insertion for the procedure.

Aim: Evaluate patient comfort, safety and the diagnostic yield of EUS-b via the nasal route.

Methods: Prospective study enrolling patients with suspected malignant or benign disease undergoing EUS-b at an oncological center from November 2019 to January 2020. Nasal insertion under midazolam was attempted in all patients, who completed a questionnaire at discharge. Data regarding the procedure, histological analysis, patient comfort and satisfaction (on a 5-point scale) were collected.

Results: 39 patients underwent diagnostic EUS-b, mostly male (64,1%) with mean age of 64,8±14,4 years. In 7 patients (17,9%) nasal insertion failed and the procedure was completed via the oral route. The mean dose of midazolam administered was 3,4±0,7mg and the mean procedure duration was 15,9±5,3min. In most patients (84,8%) only one site was sampled. Most sampled locations were station 7 (53,3%) and lung lesions (26,7%). No serious complications were reported.

Perceived patient comfort during the procedure was 4,1/5 and patients’ reported comfort was 4,0/5. Overall satisfaction was 4,3/5. All patients declared willingness to repeat the procedure if necessary.

Adequate specimens were obtained in 83,3% and diagnostic yield was 76,7%.

Conclusion: Transnasal EUS-b under conscious sedation is feasible and well tolerated when nasal anatomy is compatible. Based on these results, a prospective multi-center trial comparing insertion routes is currently underway.