Complication rate of EUS FNA and EBUS TBNA in mediastinal nodal aspiration: A meta analysis
Introduction: Esophageal and endobronchial ultrasound guided fine needle aspiration (EUS FNA/EBUS TBNA) are rapidly spreading minimally invasive techniques for the diagnosis and staging of lung cancer and sarcoidosis. Generally, endosonographic procedures are considered to be safe although several severe complications have been reported in case reports. We performed a meta analysis to assess the morbidity of EUS and EBUS for mediastinal nodal analysis. Methods: A Pubmed and Embase search was performed including all original studies (1999 October 2010) using EUS and EBUS for mediastinal nodal analysis. Case reports and studies not mentioning procedure morbidity were excluded from analysis. Results: 353 studies (118 EUS; 74 EBUS; 10 both) were reviewed of which 151 were excluded form analysis. The other 202 studies consisted of 17200 patients (EUS: 7504 patients, EBUS: 8742, both 954) In those patients, 72 complications (0.42% were reported of which 36 severe (0.21% (pneumothorax, n=9; thoracal bleeding, n=5; esophageal rupture, n=5; mediastinitis, n=4) and 36 minor (0.21% (minor pain, n=10; sore throat, n=9; hemoptysis, n=4; fever, n=2) Of the severe complications 20 occurred at EUS (0.27% and 12 at EBUS (0.14% No procedure related deaths were reported. Conclusions: The morbidity of mediastinal nodal endosonography is low and mortality has not been reported. The complication rate might well be an underestimated due to underreporting, publication and performer bias. Further prospective evaluation is warranted to determine the actual complication rate of endosonography and identify possible subsets of patients that are at risk for complications.