• Reference Number: HEY211-2024
• Departments: Endoscopy, Respiratory Medicine
• Last Updated: 1 May 2024

Introduction

This leaflet has been produced to give you general information about your procedure. Most of your questions should be answered by this leaflet/booklet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a Bronchoscopy and EBUS?

Bronchoscopy

Bronchoscopy is a camera test to examine your air tubes using thin flexible tube with a camera (bronchoscope). It is passed through your nose or mouth to the back of throat, through voice box into the windpipe (trachea) and the air tubes (Bronchi) inside your lung. This helps your doctor to examine inside of your air tubes and take samples (biopsy) if needed.

EBUS

EBUS uses thicker bronchoscope with a tiny ultrasound attached to the tip of camera tube. This is passed through your mouth to the back of throat and through voice box into the windpipe (trachea) and air tubes (Bronchi) inside your lung. This enables your doctor to locate enlarged lymph glands/lung mass next to your wind pipe or air tubes to take samples using a fine needle.

You may need either or both procedures in one setting and your doctor will discuss this with you. Please note this procedure is done under conscious sedation, meaning you will be given medication to relax and tolerate the procedure whilst we are still able to communicate with you as per need.

Why do I need this test?

Your doctor has asked for this test after reviewing your recent scan to examine and take samples from your air tubes (Bronchoscopy) or lymph glands or lung mass next to your air tubes (EBUS). This helps in diagnosing the cause of your symptoms and lung findings such as:

• Inflammation in glands caused by sarcoidosis.
• Infection such as Tuberculosis and other infections caused bybacteria/virus/fungi.
• Cancer in lymph glands due to lung or other type of cancers. If performed for cancer this procedure not only helps with identifying the type of cancer to dictate your treatment but also helps accurately stage the cancer.
• Cancer or abnormal area inside air tubes.

Can there be any complications or risks?

Both Bronchoscopy and EBUS are safe procedures and serious or life threatening complications are rare. You may experience some of the following side effects:

• Cough throughout and after procedure, though it is significantly suppressed due to medications used for this procedure.

• Bleeding leading to coughing up of blood during and after procedure. This usually improves within 24 hours. If this persists, please see contact details at the end of this leaflet.

• Sore throat and hoarse voice which usually improves in a few days.

• Temperature after procedure which responds well to Paracetamol.

• Fast heart rate (Arrhythmia). Your doctor may abandon the procedure and treat the fast heart rate if needed.

• Side effects of sedation including excessive drowsiness and slowing down of breathing. In severe cases, an antidote can be used to reverse the effects of medications given during procedure.

• Lung collapse due to puncture of lung (pneumothorax) or escape of air into middle of the chest (pneumo-mediastinum) is extremely rare. If suspected, your doctor may arrange a chest X-ray (CXR) and you may need an admission into Hospital to drain this with a chest tube. A study observed in our centre for patients who had undergone EBUS showed no such cases.

• Risk of death is rare and reported in literature as 1 in 5000. This is usually reported in very ill patients with advanced disease and we avoid offering this procedure in such cases.

• In some cases, despite the best efforts, the sample obtained does not give a complete set of information required for your treatment. In such scenario, your doctor may arrange a repeat procedure.

What are the alternatives to this test?

It is likely that you have been offered this test as the best possible means to get maximum information about your condition using the least invasive route. There may or may not be an alternative to bronchoscopy. Please discuss with your consultant if any other options are available.

The alternative procedure to EBUS is called mediastinoscopy. This is more invasive test and involves an operation done under general anesthesia by  Thoracic Surgeons.

How do I prepare for the procedure?

• Please do not eat or drink for a minimum of 4 hours before your appointment time. This is to protect your lungs and prevent you inhaling stomach contents during the procedure.

• Apart from diabetes and bloods thinning medication (see below), please take your routine medication with a small sip of water.

• If you take inhalers for Asthma /COPD, please ensure to take them as usual and bring your inhalers with you on the day of your test.

• If you are taking blood thinning medication, the Endoscopy Team will call you to advice when you should take your last dose before the procedure. A list of such medications include:

• If you are taking any blood thinning agent not listed above, please contact the Endoscopy Booking Team on the number provided at the end of this leaflet.

• If you take tablets for Diabetes, the booking team will send you an information sheet to say when to stop them before the procedure. If you take Insulin, the Endoscopy Team will call you to give you further advice.

What happens when I arrive for procedure?

On arrival to the Endoscopy Unit, the receptionist will direct you to a friendly staff nurse who will perform routine assessment before  procedure. This will involve general questions around your health, allergies and medications and recording your vital observations including your blood pressure, temperature, heart rate and oxygen levels. Please remove any false nails / nail varnish for an accurate assessment of your oxygen levels.

You will then be seen by a Consultant or trainee Doctor who will explain the procedure and answer any questions you may have related to the procedure. Once you are satisfied, you will be asked to sign a consent form for the procedure. Please note you can ask for a copy of this consent form for your records.

A cannula (needle) will be inserted in the back of your hand or in your arm to give you sedation for the procedure. You do not need to change into a hospital gown, therefore please wear comfortable clothing. You will be asked to remove dentures (if not fixed) and glasses before the procedure.

The staff nurse will guide you to the procedure room where another safety check will be performed by the team.

What happens during the procedure?

You will be lying flat on your back for EBUS Bronchoscopy can be performed  in sitting position as well. The test is performed under conscious sedation, meaning you are relaxed and sleepy enough to tolerate the procedure and at the same time we can communicate with you. Most people do not remember the events during the procedure. You will be given local anaesthetic in the form of throat spray, which can make you cough or bring tears to your eyes before numbing the back of your throat. You will have sedatives via the needle in your hand, Midazolam if performing bronchoscopy alone. For EBUS a dual sedation with additional injectable morphine is given. Once the bronchoscope is passed into your air tubes, more local anaesthetic is given.

During Bronchoscopy, samples may be taken using a small biopsy forcep, brush or a wash which helps to collect cells from the lining of air tube.

During EBUS, once the lymph node / lung mass has been identified with an ultrasound, a fine needle is passed to take samples. Your doctor will try to take samples from more than one area.

The procedure usually takes 30 to 60 minutes depending on the type of procedure and number of samples taken. You will be able to wake up soon after the procedure.

What happens after the procedure?

You will be taken to a recovery area for observation, usually for 2 to 4 hours. Once you are able to drink and your vital observations are stable, you will be allowed to leave the department.

You must arrange for someone to drive you back home and be with you at home for the night. If you cannot arrange for someone to be with you, please let the team know at the time of booking the procedure. We may need to arrange an overnight stay in hospital in advance.

It is strongly recommended for the next 24 hours you must not:

• Drive ( will not be insured to do so)
• Sign legal documents
• Operate dangerous machinery
• Stay alone

When will I know the results?

Most biopsy results take up to 7 days to be reported. In the setting of cancer diagnosis, the samples may need sending to other city laboratories and it may take additional days to get a full report. Please see below for useful contacts.

For routine results, your consultant will arrange a clinic appointment in due course to discuss the results with you.

For urgent results, you may get a call from the Lung Cancer Nurse after your case is discussed in  next MDT (lung cancer multi-disciplinary meeting). If you have any concerns or questions, please see the contact section.

Contact details:

 For booking related issues contact the Endoscopy Department on tel: 01482 622069

For routine procedure/results related concerns, contact your consultant’s Secretary. If you are under a Respiratory team, call tel: 01482 622373

For lung cancer related procedure/results, contact the Lung Cancer Specialist team on tel: 01482 461090 (Monday to Friday from 9:00 am to 4:00 pm.