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Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation
Mohamad A Eloubeidi1, Ashutosh Tamhane, Shyam Varadarajulu
1Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA. eloubeidi@uab.edu
Background:
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.
Objective:
To evaluate the frequency of major complications after EUS-FNA of solid pancreatic masses.
Design:
Prospective cohort study.
Setting:
Tertiary University based referral center for pancreatico-biliary disorder.
Patients:
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.
Main Outcomes Measurements:
Major complications were defined as acute pancreatitis, bleeding, infection, perforation, use of reversal medication, hospitalization or death.
Results:
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.
Limitations:
Lack of surgical gold standard and referral to a tertiary center.
Conclusions:
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.
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