Beaudoin Stéphane, Martel Simon, Pelletier Sabrina, Lampron Noël, Simon Mathieu, Laberge Francis, Delage Antoine
*McGill University Health Center, Division of Respirology, Montréal †Department of Respirology and Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec ‡Faculty of Medicine, Université Laval, Québec, QC, Canada.
J Bronchology Interv Pulmonol. 2016 Jan;23(1):39-45. doi: 10.1097/LBR.0000000000000249.
Linear endobronchial ultrasound (EBUS) is a safe and accurate sampling method for mediastinal adenopathy. The transnasal approach has been proposed to improve patient comfort, but no data compare the oral and nasal routes. The objective was to compare patient comfort during linear EBUS under conscious sedation between the oral and the nasal routes.
An open-label randomized study comparing the 2 insertion routes for linear EBUS was conducted. Standardized protocols for sedation and topical anesthesia were used. Primary outcome was subjects' comfort measured by a 10-point scale filled 2 hours after the procedure. Willingness to return for a repeat examination, procedural characteristics, complications, and diagnostic yields were also compared.
A total of 220 subjects were randomized and allocated to the nasal (n=110) or oral (n=110) route. Twenty-seven subjects in the nasal group (24.5%) had a failed nasal insertion but were analyzed in the nasal group. Procedural characteristics were similar (EBUS duration, doses of sedatives and lidocaine, number of stations sampled, complications). There was no difference between the nasal and oral groups in subjects' comfort (8.3 vs. 8.3, respectively, P=0.99), overall patient satisfaction (8.9 vs. 9.1, respectively, P=0.34), subjects' willingness to return (96% vs. 97%, P=1.00), and physician-reported subject comfort. Rates of adequate specimens and diagnostic yields did not differ significantly between the groups.
For linear EBUS, the nasal and oral approaches confer a similarly high degree of patient comfort with similar complication rates and diagnostic yield. Patient and physician preferences should dictate the route of insertion.
线性支气管内超声（EBUS）是一种用于纵隔淋巴结病的安全且准确的采样方法。经鼻途径已被提出以提高患者舒适度，但尚无数据比较经口和经鼻途径。目的是比较在清醒镇静下进行线性EBUS时经口和经鼻途径患者的舒适度。
进行了一项开放标签的随机研究，比较线性EBUS的两种插入途径。使用了标准化的镇静和局部麻醉方案。主要结局是术后2小时通过10分制量表测量的受试者舒适度。还比较了再次检查的意愿、操作特征、并发症和诊断率。
总共220名受试者被随机分组并分配至经鼻组（n = 110）或经口组（n = 110）。经鼻组中有27名受试者（24.5%）经鼻插入失败，但仍在经鼻组中进行分析。操作特征相似（EBUS持续时间、镇静剂和利多卡因剂量、采样部位数量、并发症）。经鼻组和经口组在受试者舒适度（分别为8.3和8.3，P = 0.99）、总体患者满意度（分别为8.9和9.1，P = 0.34）、受试者再次检查的意愿（96%对97%，P = 1.00）以及医生报告的受试者舒适度方面无差异。两组之间充足标本率和诊断率无显著差异。
对于线性EBUS，经鼻和经口途径在患者舒适度、并发症发生率和诊断率方面相似。患者和医生的偏好应决定插入途径。
