Factors Predictive of Adverse Events Associated with Endoscopic Ultrasound-Guided Fine Needle Aspiration of Pancreatic Solid Lesions

Abstract

BackgroundEndoscopic ultrasound-guided fine needle aspiration (EUS-FNA) provides high diagnostic accuracy with a low incidence of procedural complications. However, it occasionally causes serious complications, and factors that increase the susceptibility to such adverse events remain unknown.AimsWe aimed to examine post-procedural events and determine risk factors associated with EUS-FNA of pancreatic solid lesions.MethodsThis single-center retrospective study included 316 consecutive patients with pancreatic solid lesions who underwent 327 EUS-FNA procedures from April 2003 to September 2011. We registered all patients undergoing EUS-FNA in the database and retrospectively ascertained the presence/absence of post-procedural adverse events.ResultsThe incidence of post-procedural adverse events, including moderate to mild pancreatitis, mild abdominal pain, and mild bleeding, was 3.4 %. Univariate analysis showed that the incidence of post-procedural events was significantly increased in patients with tumors less than or equal to 20 mm in diameter (P < 0.001), those with pancreatic neuroendocrine tumors (PNET) (P = 0.012), and patients who had intervening normal pancreas for accessing the lesion (P = 0.048). Multivariate analysis identified tumors measuring less than or equal to 20 mm in diameter (OR 18.48; 95 % CI 3.55–96.17) and case of PNETs (OR 36.50; 95 % CI 1.73–771.83) were an independent risk factors.ConclusionsEUS-FNA of pancreatic solid lesions is a safe procedure. However, pancreatic lesions with small diameters and pancreatic neuroendocrine tumors are important factors associated with adverse events after EUS-FNA.

The usefulness of endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of pancreatic neuroendocrine tumors based on the World Health Organization classification

“…Itoi et al compared the characteristics of EUS-FNA needles under several conditions and concluded that large-gauge needles were difficult to insert if tight angulation of the endoscope was used, whereas thin needles enabled easier insertion [36]. The complication rate with EUS-FNA using a 22-G needle in this study was low, similar to that reported elsewhere [17,22,37,38]. The diagnostic ability of EUS-FNA with a 22-G needle in our study was 92.1%, similar to other published data [22,37].…”

Endoscopic ultrasound-guided fine-needle biopsy of small solid pancreatic lesions using a 22-gauge needle with side fenestration

“…In this study, the overall incidence of adverse events was 3.4 % (11/327 cases), with 8/11 cases (73 %) involving lesions B20 mm in diameter compared to 3/11 (27 %) cases involving lesions [20 mm in diameter (p \ 0.001) [18].…”

“…This may lead to pancreatic damage and adverse effects, such as pancreatitis and bleeding. Moreover, the possible causes of pancreatitis include injury to the main pancreatic duct or its branches [18].…”

Basing Treatment Strategy for Non-functional Pancreatic Neuroendocrine Tumors on Tumor Size

“…Evaluation by FNA may be useful. However, insufficient samples, especially with small tumors, 31 or an adverse event such as pancreatitis, 32 precluded us from routinely performing FNA in all patients with pancreatic tumors, and let us advocate the observation of well-enhanced pancreatic small tumor, although the radiological diagnosis of PNET may be inaccurate.…”