EUS-guided FNA is effective for establishing tissue diagnosis in suspected pancreatic cancer. However, data on the frequency of major complications following EUS-FNA are limited.
To evaluate the frequency of major complications after EUS-FNA of solid pancreatic masses.
Prospective cohort study.
Tertiary University based referral center for pancreatico-biliary disorder.
Consecutive patients who underwent EUS-FNA of a solid pancreatic over a 42-month period. All immediate complications were recorded by the endosonographer. Late complications were assessed at 72 hours and at 30-days after the procedure.
Major complications were defined as acute pancreatitis, bleeding, infection, perforation, use of reversal medication, hospitalization or death.
A total of 355 consecutive patients with a solid pancreatic mass underwent EUS FNA. Major complications were encountered in 9 patients (2.54%, 95% CI 1.17-4.76). Acute pancreatitis occurred in 3 of 355 (0.85 %, 95% CI 0.17-2.45); 2 patients were hospitalized, and 1 patient recovered with outpatient analgesics. Three patients were admitted for severe pain after the procedure; all were treated with analgesics and subsequently discharged with no sequela. Two patients (0.56%, 95% CI 0.07-2.02) developed fever and were admitted for intravenous antibiotics; 1 patient recovered with intravenous antibiotics and the other required surgical debridement for necrosis. One patient required the use of reversal medication. Overall, 1.97% (95% CI 0.80-4.02) of the patients were hospitalized for complications (range 1-16 days). None of the patients experienced clinically significant hemorrhage, perforation, or death. No clear predisposing risk factors were identified.
Lack of surgical gold standard and referral to a tertiary center.
EUS-FNA of solid pancreatic masses infrequently leads to major complications. Our results can be used by endosonographers to counsel patients before EUS-FNA of solid pancreatic masses.
"The safety profile of EUS-FNA is excellent [40, 41]. The majority of complications are encountered during aspiration of cystic lesions, and prophylactic antibiotics are recommended to reduce the risk of sepsis . "
[Show abstract][Hide abstract] ABSTRACT: Endoscopic ultrasound-guided fine needle aspiration is a multistep procedure that involves proper clinical indication, correct selection of needles, adapting evidence-based techniques such as the fanning maneuver and not routinely using suction or the stylet for tissue sampling, and establishing reliable cytopathology support. Integrating cytopathology in the training curriculum and developing a more flexible platform of needles and echoendoscopes are likely to further advance the field of endosonography. This review aims to summarize the technical issues that are key to performing high-quality endoscopic ultrasound-guided fine needle aspiration.
Electronic supplementary material
The online version of this article (doi:10.1007/s12325-014-0129-5) contains supplementary material, which is available to authorized users.
Advances in Therapy 06/2014; 31(7). DOI:10.1007/s12325-014-0129-5 · 2.27 Impact Factor
"EUS-FNA of a pancreatic mass carries the risk of pancreatitis [Figure 3] as the needle often traverses normal pancreatic parenchyma and/or ducts to reach the target lesion. Acute pancreatitis has been reported in up to 2% of pancreatic EUS-FNA. The needle gauge and type of pancreatic lesion has not been shown to increase the risk of pancreatitis. "
[Show abstract][Hide abstract] ABSTRACT: Endoscopic ultrasound (EUS) guided fine-needle aspiration (FNA) is often the preferred technique for tissue acquisition in the diagnosis of suspected intrathoracic and intraabdominal pathology. Although EUS FNA is a safe and accurate procedure, it has been associated with a low risk of adverse events. The unique properties of the echoendoscope and its ability to acquire tissue outside of the gastrointestinal lumen impart risks that are not associated with routine endoscopic procedures. In this review, we discuss the risk of perforation related to the echoendoscope itself and adverse events related to FNA of solid masses including infections, bleeding, pancreatitis and pancreatic duct leak, bile duct leak and tumor seeding. We also provide tips on how to avoid the most common adverse events related to EUS-FNA.
"It has been estimated that approximately 6% of patients undergoing pancreaticoduodenoectomy have a benign process. Another 6% of patient may have an unusual histology, including tumors that have metastasized to the pancreas. Therefore, to minimize the number of patients undergoing non-therapeutic surgeries, a pre-treatment tissue diagnosis is strongly recommended in most cases. "
[Show abstract][Hide abstract] ABSTRACT: Endoscopic ultrasound (EUS) has evolved to become a crucial tool for the evaluation of pancreatic diseases, among them solid pancreatic lesions. However, its ability to determine whether a lesion is malignant or not is difficult to establish based only in the endosonographic image. EUS-guided fine needle aspiration (EUS-FNA) allows obtaining a cytological and/or histological sample from pancreatic lesions, with a high overall accuracy and low complication rates. Although the clinical usefulness of EUS-FNA for pancreatic diseases is widely accepted, the indications for tissue diagnosis of pancreatic lesions suspected to be malignant is still controversial. This review highlights the diagnostic accuracy and complications of EUS-FNA, focusing on its current indications.
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