Complicationsarising from endobronchial ultrasound (EBUS): Impact of trainee participation

Background: Despite the widespread use of EBUS -Transbronchial needle aspiration (TBNA), the reported complication incidence is relatively low. This could be due to under-reporting. Aim: To assess the complication rate (patient adverse events and scope damages) of performing EBUS-TBNA and the impact of trainee participation on complication rate. Methods: Retrospective analysis of all consecutive EBUS-TBNA performed in at Singapore General Hospital between 2008 and 2013. Reported complications were classified into major or minor events. Damages to scopes and cost of repair were also recorded. The impact of trainee participation was analysed. Results: 597 EBUS-TBNA procedures were performed. 39 complications occurred during performance of EBUS-TBNA; 2 major and 37 minor. One patient died within 24 hours of EBUS-TBNA; attributed to acute myocardial infarction. One patient had superior vena cava obstruction and had severe contact bleeding prior to TBNA requiring intubation. Rest of EBUS complications were minor. Trainees were involved in 71.7% (28/39) of EBUS-TBNA with complications, but complication rates have reduced from 20.8% in 2011 to 14.86% in 2013. During this period, the EBUS scope was damaged 7 times requiring S$55,740 (€32,325) for repair.The frequency of EBUS scope damage has reduced from 3 times in 2012 to none in 2013. Scope damages related to trainee participation was 85% (6/7). Conclusions: Complication rates and number of scope damages were higher with trainee participation. However, with better training and more experience these complications can be reduced.