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Assessment of complications of EUS-guided fine-needle aspiration
D O'Toole1, L Palazzo, R Arotçarena
1Fédération Medico-Chirurgicule d' Héputo-Yastroentérologic, Hôpital Beaujon, Clichy, France.
Background:
EUS-guided fine-needle aspiration (EUS-FNA) permits both morphologic and cytologic analysis of lesions within or adjacent to the GI tract. Despite increasing use of this technique, the safety and overall complication rates remain poorly defined.
Methods:
During a period of 20 months, 322 consecutive patients underwent EUS-FNA in 2 centers. All procedures were performed with the patients under general anesthesia. All complications (including local complications resulting from endoscopy/aspiration or clinical complications after the procedure) were evaluated. Potential risk factors for the development of complications were also analyzed including site and nature of the lesion, presence of portal hypertension, and number of needle passes.
Results:
A total of 345 lesions were aspirated in 322 patients. EUS-FNA involved the pancreas in 248 cases. Pancreatic lesions included solid (134) and cystic (114) types, which required a mean of 2.5 and 1.4 needle passes, respectively. Complications were observed in 4 (1.2%) patients after aspiration of pancreatic cystic lesions (acute pancreatitis, n = 3; aspiration pneumonia, n = 1) and all cases of pancreatitis resulted from FNA of lesions in the head/uncinate process. No complications resulted from FNA of solid pancreatic lesions. Complications were not observed after FNA of lymph nodes (n = 62) and one case of aspiration pneumonia was observed after FNA of a stromal tumor. EUS-FNA was performed without complication in 16 patients (5%) with portal hypertension. The number of needle passes was not predictive of complications.
Conclusions:
Because the overall risk of complications from EUS-FNA was relatively low (1.6%) with no severe or fatal incidents and although the risk appears slightly higher than that for standard EUS alone, the safety of EUS-FNA appears acceptable based on this analysis from an experienced center.
Insights
Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe procedure for diagnosing gastrointestinal lesions. The overall complication rate was low at 1.6%, with no severe incidents reported.
Area of Science:
- Gastroenterology
- Endoscopic Procedures
- Diagnostic Imaging
Background:
- Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is increasingly used for analyzing GI tract lesions.
- However, its safety and complication rates require further definition.
Purpose of the Study:
- To evaluate the safety and complication rates of EUS-FNA.
- To identify potential risk factors associated with complications.
Main Methods:
- A prospective study of 322 patients undergoing EUS-FNA over 20 months.
- Complications were meticulously recorded and analyzed.
- Risk factors such as lesion site, type, portal hypertension, and needle passes were assessed.
Main Results:
- A total of 345 lesions were aspirated, with 248 in the pancreas.
- Complications occurred in 1.2% of pancreatic cystic lesion aspirations (3 pancreatitis, 1 pneumonia).
- No complications arose from solid pancreatic lesions or lymph node aspirations.
Conclusions:
- EUS-FNA demonstrated a low overall complication rate of 1.6%.
- The procedure is considered safe, with no severe or fatal outcomes.
- EUS-FNA is an acceptable diagnostic tool when performed by experienced centers.