Transesophageal EUS of mediastinal and pulmonary lesions: An Italian survey from i-EUS Working Group

Background and Objectives: Pulmonary and mediastinal masses are diagnostic challenges for digestive endosonographers, and patients with these conditions are usually managed in thoracic or pulmonology units. EUS with tissue acquisition can result in adequate samples for histological examination and molecular analysis. Its spread among digestive endosonographers is limited; thus, we aimed to investigate the current management practices among the EUS Italian centers for those patients with mediastinal or pulmonary lesions to identify the principal areas of disagreement and help guide future research towards useful standardization. Methods: A 44‑question survey was sent during a temporal trend of 3 months to the endosonographers in Italian centers performing EUS. The survey includes questions with either a single answer choice or with multiple options exploring different aspects of the EUS done for the evaluation of thoracic lesions. The questions were grouped into specific sections: expertise of the center, periprocedural management, procedural aspects, and future perspectives. Results: Thirty-nine centers completed the survey, 27 (69.2%) from the north of Italy. Only 2 centers among the responders did not perform any mediastinal EUS (5.13%). The majority of centers (22, 59.5%) performed between 0 and 30 mediastinal EUS yearly, and only 3 centers did more than 100 mediastinal EUS per year. Responders were mainly gastroenterologists (34, 87.2%) versus surgeons (5, 12.8%). Only 5 centers performed mediastinal EUS in a shared room with bronchoscopy and endobronchial ultrasound (13.5%). The procedure was considered simple for 20 (54.1%) responders, complex for 5 (13.5%), and needed to be performed in a tertiary thoracic center for 12 (32.4%). Franseen and Fork tips were the most used tips (67.6% and 27%, respectively), and the most common needle diameter was 22 gauge (86.5%). Fifteen centers (40.5%) preferred deep sedation with an anesthesiologist without endotracheal intubation. The main growing indications appear to be local EUS-guided treatments (tumors or collections). Conclusions: This is the first survey assessing an evaluation on mediastinal/pulmonary EUS, which is well represented in Italy. Nonetheless, centers largely have low volumes of these procedures. Our results show heterogeneity in the management of patients affected with mediastinal/pulmonary lesions needing tissue acquisition. More studies also involving pulmonologists, thoracic surgeons, and oncologists are needed to increase data and understanding regarding this procedure.