Original Articles
Assessment of complications of EUS-guided fine-needle aspiration,☆☆

https://doi.org/10.1067/mge.2001.112839Get rights and content

Abstract

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 stromel 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. (Gastrointest Endosc 2001;53:470-4.)

Section snippets

Patients and methods

From January 1998 to October 1999, 322 consecutive patients underwent EUS-FNA to establish a diagnosis for lesions involving, or adjacent to, the upper or lower GI tract. These included suspected upper or lower GI tract, pancreatic, liver, pelvic and mediastinal malignancies. EUS-FNA was also performed to confirm diagnoses in patients with cystic pancreatic lesions, tuberculous lymphadenopathy, and other benign disorders. The procedures were performed in 2 centers by 3 experienced

Results

The patient population included 322 patients (171 men) with a mean age of 59.5 years. EUS-FNA was performed in a total of 345 lesions and required a mean of 2.1 passes per lesion (± 1.0). The overall complication rate was 1.6% (5 of 322 patients). There was no death and no patient required surgery.

The pancreas was the most frequent site of EUS-FNA and was aspirated in 248 (72%) cases. Antibiotics were given prophylactically in 66% of cases before aspiration of pancreatic cysts. Of the

Discussion

EUS-FNA is an accurate technique for differentiating benign and malignant lesions of the pancreas, lymph nodes, and those adjacent to the upper and lower GI tract wall.6, 7, 9, 10, 11, 12 Although it has been suggested that complication rates are greater in patients undergoing EUS-FNA compared with standard upper endoscopy, diagnostic EUS, or percutaneous FNA,11 the exact complication rate for this procedure remains poorly defined.

The overall complication rate in this study was 1.5%, which is

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Reprint requests: Dermot O'Toole, MD, Service de Gastroentérologie, Hôpital Beaujon, 100, boulevard du Général Leclerc, F-92118 Clichy Cedex, France.

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Gastrointest Endosc 2001;53:470-4

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