State-of-the-Art Service for Groote Schuur Hospital Respiratory Clinic

The Division of Pulmonology at Groote Schuur Hospital has recently acquired an Endobronchial ultrasound (EBUS) bronchoscope through a generous donation by the University of Cape Town. This equipment will provide a service to the patients of the Respiratory Clinic at Groote Schuur Hospital, bringing it in line with centres in the United States and Europe where EBUS bronchoscopy is now the standard of care; reducing the need for open surgery (mediastinoscopy) by 90%. Groote Schuur Hospital is now one of only two hospitals in the country (both public and private) that offers this procedure.

What is EBUS Bronchoscopy?

Mediastinoscopy has long been the traditional method for sampling lymph glands or masses next to the trachea within the chest. EBUS bronchoscopy is a novel technique that allows these glands or masses to be sampled from within the windpipe or major airways, using real-time ultrasound guidance.

A thin flexible telescope (bronchoscope) is passed through the mouth and into the windpipe and major airways, after which images of the surrounding tissues are obtained from an ultrasound probe attached to the end of the bronchoscope. The operator uses these images as a guide when taking samples of cells with a thin needle at the end of the bronchoscope from the masses or lymph glands suspected of disease.

Benefit of Endobronchial Ultrasound Bronchoscopy

The service allows for quicker diagnosis without the pain and discomfort of surgery, or the cost and inconvenience of admission to hospital. The procedure takes place under local anaesthesia or with conscious sedation and can be done as an Outpatient Service for patients being investigated for lung pathologies that involve lymph nodes such as tuberculosis, sarcoidosis and lymphoma; as well as for the diagnosis of staging of lung cancer. The procedure lasts about forty-five minutes and patients are able to go home on the same day, usually within two hours.

Success stories up to now of patients benefitting from EBUS

Ms ZK is a 23-year-old woman referred to our clinic with enlarged glands around the windpipe and major airways, discovered after a chest X-ray was done when she was applying for a permit to work in the United Kingdom. In the past, the standard way of investigating this problem would have been open surgery (mediastinoscopy). With EBUS bronchoscopy, we were able to make the diagnosis of stage I sarcoidosis (a benign and self-limiting disease which resolves without any treatment) without the pain and discomfort of surgery, and without leaving any surgical scars.

Mr LM is a 25-year-old man referred to us complaining of several weeks of night sweats and loss of weight. Tuberculosis was strongly suspected, but all sputum investigations were negative. A CT scan of the chest showed that the glands on the left side were enlarged, without any evidence of TB in the lung tissue itself. Via EBUS bronchoscopy, the glands were sampled, TB was proven on culture, and the correct treatment was started. The use of this technology allowed a confident microbiological diagnosis of drug-sensitive TB to be made.

Mrs FM is a 65-year-old woman with a history of heavy cigarette smoking, high blood pressure, heart disease and emphysema. She was referred with shortness of breath and a large mass next to her windpipe. A surgical biopsy under anaesthesia would have been dangerous in light of her many other medical problems. We were able to diagnose a type of lung cancer called adenocarcinoma on EBUS bronchoscopy, and she was referred to the oncologists for chemotherapy.

Western Cape Health Minister Theuns Botha officiated at the event. In his address he congratulated the involved staff at Groote Schuur Hospital on acquiring the advanced ultrasound technology and taking the lead in offering the EBUS bronchoscopy procedure.

Minister Botha said: "The event once again focuses on Western Cape Government's focus on wellness. We are putting systems in place that will enable us to detect illness at an earlier stage."

Groote Schuur Hospital will be hosting a media event today, the day before World No Tobacco Day, where the Division of Pulmonology will demonstrate the EBUS Bronchoscopy procedure. The event will be attended by stakeholders from UCT Faculty of Health Sciences, as well as representatives of Western Cape Government Health.