Comparison of nasal and oral linear endobronchial ultrasound: a retrospective single-center study

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe and effective technique for lung cancer staging and evaluation of mediastinal and hilar lesions. Although oral insertion is widely used, the nasal route may improve scope stability and patient tolerance, but comparative data remain limited. METHODS: This retrospective single-center study included adults who underwent linear EBUS-TBNA for mediastinal or hilar lymphadenopathy between January 2019 and December 2023. Patients were grouped according to insertion route. Standardized topical anesthesia, conscious sedation, procedural monitoring, and post-procedural recovery criteria were used. Hemodynamic parameters, oxygen saturation, sedative and analgesic requirements, lymph node sampling, diagnostic results, complications, and post-procedural complaints were compared between the nasal and oral groups. RESULTS: Nasal EBUS was performed in 158 patients (39.1%) and oral EBUS in 246 patients (60.9%). Baseline and intraprocedural oxygen saturation were similar between groups, whereas post-procedure oxygen saturation was higher in the nasal group. Oral EBUS was associated with a greater intraprocedural heart-rate increase, higher midazolam and propofol requirements, more frequent hypoxemia-related procedure interruption, and a higher re-EBUS rate. The nasal route was associated with modestly shorter procedures and slightly higher numbers of sampled lymph node stations and punctures per examination. Diagnostic categories and overall complication rates were comparable between groups. CONCLUSION: In this large single-center retrospective cohort, nasal linear EBUS-TBNA was a feasible and safe alternative to oral EBUS-TBNA. The nasal route provided comparable diagnostic performance and complication rates while reducing sedative requirements, hypoxemia-related interruptions, and procedure time. These findings support the nasal route as a practical option for interventional pulmonology units experienced with linear EBUS.