EUS-B-FNA for Diagnosis of Sarcoidosis: A Note of Caution

experienced bronchoscopists [6] ; the learning curve for EUS-BFNA is unknown, and there is no specific training or curriculum for this procedure. We therefore suggest that the technical challenges of EUS-B-FNA should not be underestimated, specifically being competent at oesophageal intubation and manipulation of the bronchoscope in the oesophagus. Finally, there is a specific safety issue with EUS-B-FNA (and EUS-FNA) sampling of station 7 nodes having been associated with an increased risk of mediastinitis and fistulae in patients with mediastinal tuberculosis [7, 8] . In summary, we support the study from Oki et al. but suggest considering EBUS-TBNA and EBB first in stage 1 and 2 sarcoidosis. We would keep EUS-B-FNA in reserve for patients with refractory cough or poor lung function but would suggest it is only performed by those with relevant experience in upper gastrointestinal endoscopy to be able to deal with any complications of EUS-B-FNA. These concerns including the relative deficiencies of the EBUS scope versus an EUS scope have prompted some of the EUS fraternity to raise concerns about the growth of EUS-B-FNA [9] . Nevertheless, we also agree future studies are required to compare the relative performance of EBUS-TBNA, EUS-B-FNA and EUS-FNA.