Endoscopic Complications Following EUS-B Fine-Needle Aspiration Performed by Interventional Pulmonologists: Incidence, Characteristics, and Prospective Cohort Analysis.

Abstract

Background: To prospectively evaluate the incidence, severity, and clinical implications of esophageal mucosal injury following esophageal ultrasound using a convex EBUS bronchoscope (EUS-B-FNA).

Methods: Prospective single-center cohort of 33 adults (37 procedures) undergoing EUS-B-FNA (February to August 2025) for diagnosis or staging of pulmonary or mediastinal lesions. Postprocedure mucosa was systematically assessed by upper endoscopy or EBUS optics and classified by type, location, and extent. Complications, diagnostic yield, sample adequacy, lesion sizes, and potential risk factors were recorded. Patients were followed for 1 month.

Results: Mucosal alterations occurred in 89.2% (33/37) of procedures: punctate lesions (48.6%; median: 1 mm, IQR: 0.5 to 2) and edema (29.7%; median: 1 mm, IQR: 0 to 2); erythema and mild hemorrhage in 5.4% each. No ulceration, perforation, stricture, or intervention was required. Two minor events occurred (self-limited vomiting, submucosal edema). No procedure was interrupted, and no readmissions or severe events occurred during follow-up. Diagnostic yield was 59.5% and sample adequacy 86.5%. Median lesion sizes were 30 mm (IQR: 26.3 to 33.8) for intrapulmonary, 17 mm (IQR: 13 to 20) for lymphadenopathy, and 29 mm (IQR: 23.5 to 34.5) for adrenal lesions. Frequent risk factors included active malignancy (n=18) and diabetes (n=11). Median of 3 needle passes. Most procedures (89.2%) used conscious sedation.

Conclusion: This first systematic evaluation of esophageal mucosal changes after EUS-B-FNA shows that minor alterations are common but clinically insignificant. The technique is safe, feasible, and diagnostically valuable when performed by interventional pulmonologists. Larger multicenter studies are needed to optimize risk stratification and procedural protocols.