Basic techniques in endoscopic ultrasound-guided fine needle aspiration for solid lesions: Adverse events and avoiding them

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.

Incidents and adverse events of endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions

“…A study enrolled 414 patients showed the AEs all occurred during the first day[ 41 ]. In accordance with a previous study, pancreatitis, infection, perforation, tumor seeding and clinically significant bleeding are the most common AEs of EUS-FNA[ 42 ]. The incidence of acute pancreatitis varies from 0% to 2.6% and bacteremia can be observed in ≤ 6% of EUS procedures and EUS-FNA[ 18 , 38 , 40 , 43 , 44 ].…”

Endoscopic ultrasound-guided techniques for diagnosing pancreatic mass lesions: Can we do better?

“…Tumor seeding is perhaps the most feared complication, however there are only limited single case reports of EUS-FNA associated tumor seeding and thus the risk is thought to be extremely low[ 81 ]. To avoid this complication, it is important to ensure the echoendoscope is as close to the suspected malignancy as possible to limit the amount of tissue traversed.…”

Endoscopic ultrasound-guided fine-needle aspiration of pancreatic lesions: A systematic review of technical and procedural variables

“…[ 100 101 102 ] Complications most commonly include perforation, pancreatitis, infection, tumor seeding, or clinically significant bleeding. [ 103 ] A multicenter study in the United States demonstrated a complication rate of 0.28%[ 104 ] while a more recent prospective study noted the complication rate as 0.85%. [ 102 ] No definite association was found between the occurrence of a complication and the type and size of the pancreatic lesion, number of passes, or history of chronic pancreatitis.…”