Having a bronchoscopy and endobronchial ultrasound (EBUS)

Whilst your doctor has requested this procedure, it is your decision to go ahead with the procedure or not. At your appointment, once you feel ready to go ahead, you will be asked to sign a consent form. However, you have the right to change your mind at any point before the procedure even after you have given consent. We do ask you to let us know in advance if you decide not to/cannot attend your appointment.  If you decide not to have the bronchoscopy/EBUS, you should discuss this carefully with your doctor. 

What is a bronchoscopy (EBUS?)

A bronchoscopy is a procedure to look directly into your large airways: these are your trachea (windpipe) and bronchi (branches of the airways).   An EBUS, a type of bronchoscopy, may be used if you require a biopsy of the lymph glands inside your chest. Figure one on the next page shows a diagram of your airways.  

How to prepare for your bronchoscopy (EBUS ) 

You may be asked to take a Covid-19 PCR test two days before the procedure and to self-isolate until the procedure. We will advise you if this is necessary.

If you take an anticoagulant tablet (warfarin, apixaban, rivaroxaban, edoxaban or dabigatran) or injection (tinzaparin or enoxaparin), or antiplatelet medication (aspirin, clopidogrel, ticagrelor or prasugrel), let your doctor or the endoscopy department know at least 10 days before the procedure. These may need to be stopped temporarily in advance. We will provide instruction on the safest way to do this.

If you take diabetes medication, you will be given additional instructions. Contact the endoscopy department immediately if these are missing.

You will need to arrange for a responsible adult to take you home after your procedure. You will not be able to drive yourself or take public transport on your own due to the sedation used in the procedure.

On the day of the procedure

Do not eat or drink for four hours before your appointment time (apart from a sip of water if taking your usual morning medicines). Make sure that the person who will be taking you back home knows where to come to pick you up around three to four hours after your appointment.

Please bring this sheet with you to your appointment as it has useful information about what to expect after the procedure.

Where do I go?

Royal Free Hospital

The endoscopy department is located on the lower ground floor. This is next to the physiotherapy gym.

Chase Farm Hospital

The endoscopy department is in zone A on the lower ground floor.

What does the procedure involve?

The bronchoscopy will be undertaken by a doctor and two to three nurses in a treatment room.

You will be asked to remove your glasses and any loose-fitting dentures and made comfortable on the couch in a sitting or lying position. If you are a wheelchair user, this will be discussed with you prior to your appointment.  

The doctor will spray your throat with local anaesthetic. A finger probe will be used to monitor your oxygen levels and heart rate. If you need oxygen, it will be provided to you through a small tube under your nostrils.

You will then be offered an intravenous sedative given through a small needle in your arm or the back of your hand. This will make you feel more relaxed and sleepier, but you will not be unconscious.

A bronchoscope, a long flexible tube about the width of a thin pencil with a light and camera at the end, will be passed through your nose or mouth. As this is inserted, the doctor will use the local anaesthetic to numb your voice box, and this may make you cough a little. The doctor passes the tube into your windpipe and examines the surface lining of your airways. The procedure usually takes between 15-20 minutes.

If you require a biopsy of the lining of the airway (endobronchial biopsy) or the lung tissue (transbronchial biopsy), this is done by passing small forceps down the bronchoscope and retrieving a small specimen. If you are having an EBUS, then the biopsy is taken by sucking a small specimen up with a needle. There are almost no nerve endings in these areas and so you do not feel the biopsy forceps or needle. When biopsies are taken the procedure will take between 30-45 minutes.  

Your doctor may also perform a ‘wash’ of part of the lungs using a mild saline (salt) solution. This involves passing a small amount of fluid through the bronchoscope and then removing it for examination. 

What happens after the procedure? 

• You will be taken to the recovery area where you will be monitored for about two hours. You won’t be able to drink or eat during this time. Once you have recovered, you will be able to go home.   
• You are advised not to drive, operate machinery, drink alcohol, or sign any legally binding documents for the next 24 hours.
• You are advised to have a responsible adult stay with you until the following morning.
• You should be able to return to work the next day unless advised otherwise. 
• If you are on anticoagulants or antiplatelets, you should be able to start these the next day unless advised otherwise.

Once at home, if you have severe chest pain, sudden shortness of breath or you cough up more than a tablespoon of blood please attend the emergency department. Streaks of blood in your phlegm are to be expected (see next paragraph).

Risks and side effects

The healthcare team will try to reduce the risk of complications and side effects. Some side effects are common (most people)  

• Sore throat, husky voice or a cough (or worsening of your usual cough).
• Bleeding from a biopsy site which shows up as streaks of blood in your phlegm. There may also be minor bleeding from your nose if this is where the bronchoscope was inserted. Minor bleeding may last up to a few days after the procedure.
• Less common side effects (fewer than one in 10 of people)
• If you have had a ‘wash’ or part of the lungs, you may develop a high temperature within 24 hours of the procedure. This is easily treated with paracetamol.
• Rare side effects (fewer than one in 100 people), some of which may become serious and can even cause death (fewer than two in 10,000 people)
• Continued bleeding from the biopsy site
• A collapsed lung requiring treatment if you’ve had a transbronchial biopsy
• A strong reaction to the sedative (over-sedation, abnormal blood pressure or heart rate)
• Allergic reaction to materials or medication used
• Severe breathlessness / low oxygen levels (respiratory failure)
• Damage to teeth (this only occurs where the tooth is already weakened) or crowns or dental bridgeworks. We use a plastic mouth guard to protect against this.
• Infection around the biopsy site if you’re had EBUS (this may become apparent several weeks afterwards)

When will I be given the results?

Your healthcare team will arrange for you to come back to the clinic for your results. These usually take up to a week to become available but may take longer. If you have no further clinic appointments, please contact your respiratory department.