From the Guidelines
Complications of Endobronchial Ultrasound (EBUS) are generally rare, with the overall complication profile remaining low, as reported in a recent study published in 2025 1. The most common complications of EBUS include:
- Bleeding
- Infection
- Pneumothorax
- Respiratory failure
- Adverse reactions to sedation Minor complications such as cough, sore throat, and fever may occur in up to 20% of patients. More serious complications like significant bleeding occur in less than 1% of cases, while pneumothorax happens in approximately 0.5-1% of procedures. The use of Rapid On-Site Evaluation (ROSE) during EBUS-TBNA has been shown to reduce procedural complications, with a complication rate of 12.6% when ROSE is used, compared to 19.1% when ROSE is not used 1. Infection is uncommon but may present as mediastinitis or lung abscess, especially in immunocompromised patients. Respiratory failure requiring ventilatory support is extremely rare but can occur in patients with severe underlying lung disease. The risk of complications can be minimized by using ROSE during EBUS-TBNA, which can help identify sample adequacy and preliminary diagnostic information, reducing the need for repeat procedures and potentially improving procedural efficiency 1. Medication-related complications include adverse reactions to sedatives like midazolam or propofol, which may cause hypotension or respiratory depression. The risk of complications increases in patients with coagulopathies, severe pulmonary hypertension, hypoxemia, or unstable cardiac conditions. Overall, the mortality rate associated with EBUS is less than 0.01%, making it a safe and preferred diagnostic procedure for mediastinal and hilar lymph node assessment 1.
From the Research
Complications of Endobronchial Ultrasound (EBUS)
- The complications of EBUS can be categorized into several types, including:
- Bleeding complications: A study found that the risk factors for grade 2 or higher bleeding events during radial EBUS-guided transbronchial biopsy include a large size of ≥30 mm and central lesion 2
- Infectious complications: Infectious complications, such as pneumonia, mediastinitis, and sepsis, can occur after EBUS-TBNA, with a complication rate of 1.23% 3
- Pneumothorax: Pneumothorax is a potential complication of EBUS, with a reported incidence of 0.03% to 0.8% 3, 4
- Device breakage: Breakage of the ultrasound bronchoscope or puncture needle can occur, with a reported incidence of 1.33% to 1.8% 3, 4
- Other complications: Other potential complications of EBUS include air embolism, tumor seeding, and procedure-related death, although these are rare 4
Risk Factors for Complications
- Several risk factors have been identified for complications after EBUS, including:
- Lesion size and location: Larger lesions (≥30 mm) and central lesions are associated with a higher risk of bleeding complications 2
- CT scan features: Cavitation, intratumoral low-density areas, and stenosis of the responsible bronchus are associated with a higher risk of infectious complications 5
- Patient characteristics: Age and comorbidities may also play a role in the risk of complications, although the evidence is limited 5
Prevention and Management of Complications
- Several strategies can be used to prevent and manage complications after EBUS, including:
- Careful patient selection and evaluation: Patients with high-risk features, such as large lesions or cavitation, should be carefully evaluated and monitored 2, 5
- Use of prophylactic antibiotics: Although the evidence is limited, prophylactic antibiotics may be considered in high-risk patients 5
- Close monitoring and follow-up: Patients should be closely monitored and followed up after EBUS to detect and manage any potential complications promptly 2, 3, 4, 5