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Endoscopic ultrasound-guided sampling of the mediastinum: Technique, indications, contraindications, and complications

Author
Julia Kim LeBlanc, MD, MPH
Section Editor
Praveen N Mathur, MB;BS
Deputy Editor
Geraldine Finlay, MD

INTRODUCTION

Endoscopic ultrasonography (EUS) is a combination of endoscopy and ultrasonography. EUS can be used to visualize and sample mass lesions of the pancreas, gastrointestinal tract, posterior mediastinum, and retroperitoneum.

The procedure and its indications, contraindications, and complications are discussed in this topic review. The evaluation of mediastinal masses and the modalities used to diagnose and stage lung cancer are presented separately. (See "Approach to the adult patient with a mediastinal mass" and "Overview of the initial evaluation, diagnosis, and staging of patients with suspected lung cancer" and "Procedures for tissue biopsy in patients with suspected non-small cell lung cancer" and "Selection of modality for diagnosis and staging of patients with suspected non-small cell lung cancer".)

TECHNIQUE AND PROCEDURE

Endoscopic ultrasonography (EUS) should be distinguished from endobronchial ultrasound (EBUS). Both visualize and guide sampling of mediastinal structures and lymph nodes, but EUS is performed during endoscopy of the gastrointestinal tract and EBUS is performed during bronchoscopy. They are complimentary; EBUS is used to examine the anterior mediastinum while EUS is used to examine the posterior mediastinum. Both procedures should only be performed by a skilled endoscopist (pulmonologist, gastroenterologist, surgeon), who has undergone appropriate training. (See "Endobronchial ultrasound: Technical aspects" and "Endobronchial ultrasound: Indications, contraindications, and complications".)

Pre-procedure preparation — The preparation for patients is similar to that described for patients undergoing upper gastrointestinal endoscopy and EUS-guided sampling for non-mediastinal lesions. (See "Overview of upper gastrointestinal endoscopy (esophagogastroduodenoscopy)", section on 'Patient preparation'.)

Most patients do not need to discontinue aspirin or nonsteroidal anti-inflammatories when undergoing EUS-guided sampling. The management of antiplatelet and anticoagulant therapy in those undergoing endoscopy is typically individualized, managed in conjunction with the prescribing subspecialist, and is discussed separately. (See "Management of antiplatelet agents in patients undergoing endoscopic procedures" and "Management of anticoagulants in patients undergoing endoscopic procedures" and "Endoscopic procedures in patients with disorders of hemostasis".)

                          
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Literature review current through: Sep 2017. | This topic last updated: Apr 04, 2017.
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