Advancements in pulmonary endosonography : the new standard to diagnose sarcoidosis and assessment of its safety profile

Author(s):
Bartheld, M.B. von
Published
2016
Publication type
Doctoral Thesis

Abstract

This thesis has dealt with the role of endosonography in the diagnosis

of sarcoidosis.

The main conclusion is that endosonography with aspiration of mediastinal lymph nodes has superior diagnostic yield in comparison to conventional bronchoscopy with taking of peripheral (TBLB) and endobronchial (EBB) tissue (80% vs 53%). Guidelines advising to perform bronchoscopy (including TBLB and EBB) as a first choice procedure to detect granulomas should be revised. In case EUS or EBUS are not available, bronchoscopy may reach comparable sensitivity but only if cTBNA, TBLB and EBB are all performed. This will increase procedure time and likely also complications because of the number of needle and forceps samples. Secondly, we assessed morbidity and mortality rates of EBUS and EUS for pulmonary indications and found that both techniques are very safe. Fatalities have been described but are very rare with a mortality rate of 0.04% and mostly occurred in patients of fragile health. Serious adverse events happen occasionally (0.15%) and are mostly of infectious origin in patients undergoing needle aspiration of cysts, sarcoid of necrotic lymph nodes.

EUSEBUSFNATBNASarcoïdosisComplicationsSafetyMediastinitisBronchoscopy
Defense date
2016-12-06
Language
English
Supervisor(s)
Annema, J.T.; Rabe, K.F.G.
Committee member(s)
Drent, M.; Grutters, J.C.; Smit, V.T.H.B.M.; Taube, C.
Qualification
Ph.D.
Degree granting institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University, Leiden
hdl
1887/44702
ISBN(s)
9789461699718