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Acute extraluminal hemorrhage associated with EUS-guided fine needle aspiration: frequency and clinical significance
A Affi1, E Vazquez-Sequeiros, I D Norton
1Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Background:
Complications with EUS-guided fine needle aspiration cytology (EUS-guided FNA) are rare and include perforation, infection, pancreatitis, and intraluminal bleeding. To date, the ultrasound appearance and clinical significance of perilesional bleeding during EUS-guided FNA have not been described. The aim of this study was to analyze the frequency of acute extraluminal hemorrhage associated with EUS-guided FNA.
Methods:
From September 1998 to October 1999 EUS-guided FNA was performed during 227 of 1104 EUS procedures. Patient follow-up and complications were recorded and retrospectively analyzed.
Observations:
Three patients were identified with acute extraluminal hemorrhage at the site of the aspiration during EUS (frequency 1.3%: 95% CI [0%, 2.8%]). The bleeding manifested as an expanding echopoor region adjacent to the sampled lesion. No clinically recognizable sequela arose from the bleeding. All patients were treated with a short course of antibiotics and outpatient observation. Preprocedure coagulation and platelet assessment did not predict which patients were at risk for this complication.
Conclusion:
Acute extraluminal hemorrhage occurring during EUS-guided FNA is a rare complication with a characteristic ultrasound appearance. Recognition of this event might be important to allow the endoscopist to terminate the procedure and thereby minimize the potential for more serious bleeding.