title: Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy.
abstract: BACKGROUND
  With the recent widespread use of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), there have been occasional reports on complications associated with its use. Previous reviews on EBUS-TBNA have been limited to studies by skilled operators, thus the results may not always be applicable to recent clinical practice. To assess the safety of EBUS-TBNA for the staging and diagnosis of lung cancer in Japan, a nationwide survey on its current usage status and complications associated with its use was conducted by the Japan Society for Respiratory Endoscopy (JSRE).
  
  
  METHODS
  A questionnaire about EBUS-TBNA performed between January 2011 and June 2012 was mailed to 520 JSRE-accredited facilities.
  
  
  RESULTS
  Responses were obtained from 455 facilities (87.5%). During the study period, EBUS-TBNA was performed in 7,345 cases in 210 facilities (46.2%) using a convex probe ultrasound bronchoscope, for 6,836 mediastinal and hilar lesions and 275 lung parenchymal lesions. Ninety complications occurred in 32 facilities. The complication rate was 1.23% (95% confidence interval, 0.97%-1.48%), with hemorrhage being the most frequent complication (50 cases, 0.68%). Infectious complications developed in 14 cases (0.19%) (Mediastinitis, 7; pneumonia, 4; pericarditis, 1; cyst infection, 1; and sepsis, 1). Pneumothorax developed in 2 cases (0.03%), one of which required tube drainage. Regarding the outcome of the cases with complications, prolonged hospitalization was observed in 14 cases, life-threatening conditions in 4, and death in 1 (severe cerebral infarction) (mortality rate, 0.01%). Breakage of the ultrasound bronchoscope occurred in 98 cases (1.33%) in 67 facilities (31.9%), and that of the puncture needle in 15 cases (0.20%) in 8 facilities (3.8%).
  
  
  CONCLUSIONS
  Although the complication rate associated with EBUS-TBNA was found to be low, severe complications, including infectious complications, were observed, and the incidence of device breakage was high. Since the use of EBUS-TBNA is rapidly expanding in Japan, an educational program for its safe performance should be immediately established.
authors.affiliation: Safety Management Committee, Japan Society for Respiratory Endoscopy, Tokyo, Japan. asano-fm@ceres.ocn.ne.jp
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Asano
authors.forename: Motoi
authors.initials: M
authors.lastname: Aoe
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Ohsaki
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Okada
authors.forename: Shinji
authors.initials: S
authors.lastname: Sasada
authors.forename: Shigeki
authors.initials: S
authors.lastname: Sato
authors.forename: Eiichi
authors.initials: E
authors.lastname: Suzuki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Semba
authors.forename: Kazuya
authors.initials: K
authors.lastname: Fukuoka
authors.forename: Shozo
authors.initials: S
authors.lastname: Fujino
authors.forename: Kazumitsu
authors.initials: K
authors.lastname: Ohmori
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003625:Data Collection; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006470:Hemorrhage / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000401:mortality*; D015996:Survival Rate