Impact and safety of endoscopic ultrasound guided fine needle aspiration on patients with cirrhosis and pyrexia of unknown origin in India

Choudhary, Narendra S.; Bansal, Rinkesh Kumar; Puri, Rajesh; Singh, Rajiv R. P.; Nasa, Mukesh; Shah, Vivek; Sarin, Haimanti; Guleria, Mridula; Saigal, Sanjiv; Saraf, Neeraj; Sud, Randhir; Soin, Arvinder S.

doi:10.1055/s-0042-112585

Cited by 13 publications

(13 citation statements)

References 17 publications

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“…Interestingly, our population did not experience any post-ERCP pancreatitis. These findings support those seen in previously published literature comparing ERCP outcomes between cirrhotics and non-cirrhotics and adds to the admittedly small data pool reporting safe outcomes with EUS-guided biopsies in cirrhotic individuals[5-8,11,12]. However, it is important to note that our study did not find an association between the use of advanced techniques and adverse events, suggesting that refinement of endoscopic techniques has improved safety of these procedures even in cirrhotic individuals.…”

Section: Discussionsupporting

confidence: 90%

Evaluating the risk of adverse events with interventional endoscopic retrograde cholangiopancreatography and endoscopic ultrasound procedures in cirrhotic patients

Yoo¹,

Epistola²,

Epistola³

et al. 2019

WJGE

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BACKGROUNDHepatic cirrhosis is associated with greater adverse event rates following surgical procedures and is thought to have a higher risk of complications with interventional procedures in general. However, these same patients often require interventional gastrointestinal procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS). While studies examining this scenario exist, the overall body of evidence for adverse event rates associated with ERCP/EUS procedures is more limited. We sought add to the literature by examining the incidence of adverse events after ERCP/EUS procedures in our safety-net hospital population with the hypothesis that severity of cirrhosis correlates with higher adverse event rates.AIMTo examine whether increasing severity of cirrhosis is associated with greater incidence of adverse events after interventional ERCP/EUS procedures.METHODSWe performed a retrospective study of patients diagnosed with hepatic cirrhosis who underwent ERCP and/or EUS-guided fine needle aspirations/fine needle biopsies from January 1, 2016 to March 14, 2019 at our safety net hospital. We recorded Child-Pugh and Model for End-stage Liver Disease (MELD-Na) scores at time of procedure, interventions completed, and 30-day post-procedural adverse events. Statistical analyses were done to assess whether Child-Pugh class and MELD-Na score were associated with greater adverse event rates and whether advanced techniques (single-operator cholangioscopy, electrohydraulic lithotripsy/laser lithotripsy, or needle-knife techniques) were associated with higher complication rates.RESULTS77 procedures performed on 36 patients were included. The study population consisted primarily of middle-aged Hispanic males. 30-d procedure-related adverse events included gastrointestinal bleeding (7.8%), infection (6.5%), and bile leak (2%). The effect of Child-Pugh class C vs class A and B significantly predicted adverse events (β = 0.55, P < 0.01). MELD-Na scores also significantly predicted adverse events (β = 0.037, P < 0.01). Presence of advanced techniques was not associated with higher adverse events (P > 0.05). When MELD-Na scores were added as predictors with the effect of Child-Pugh class C, logistic regression showed MELD-Na scores were a significant predictor of adverse events (P < 0.01). The findings held after controlling for age, gender, ethnicity and repeat cases.CONCLUSIONIncreasing cirrhosis severity predicted adverse events while the presence of advanced techniques did not. MELD-Na score may be more useful in predicting adverse events than Child-Pugh class.

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Section: Discussionsupporting

confidence: 90%

Evaluating the risk of adverse events with interventional endoscopic retrograde cholangiopancreatography and endoscopic ultrasound procedures in cirrhotic patients

Yoo¹,

Epistola²,

Epistola³

et al. 2019

WJGE

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“…The fourth one is the ability to obtain contrast-enhancement (CE) images, which improve the diagnostic performance in the case of focal lesions [ 7 ]. The last one is the ability to perform EUS-guided liver biopsy, which seems to be safer than the percutaneous route of biopsy, especially in patients with liver cirrhosis ant its accompanying coagulation disorder [ 8 ].…”

Section: Advantages Of Endoscopic Ultrasound (Eus) In Evaluating Lmentioning

confidence: 99%

A State-of-the-Art Review on the Evolving Utility of Endoscopic Ultrasound in Liver Diseases Diagnosis

et al. 2020

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Liver diseases are amongst the most common diseases worldwide and manifest as a parenchymatic and/or biliary injury due to several causes as well as focal liver lesions, ranging from benign to malignant ones. The diagnosis of liver diseases is based mainly on biochemical and advanced imaging studies and, when required, on liver biopsy. Endoscopic ultrasound (EUS), which combines endoscopy and ultrasonography, is one of the main examination techniques used in gastroenterology as it is applied to evaluate abnormalities in the lumen of the upper and lower gastrointestinal tract and to define pancreatic and hepato-biliary features, often in chronic patients. Given its high spatial resolution and its proximity to the liver, EUS is gaining popularity in the diagnostic work up of liver diseases. This is a comprehensive overview of the current literature on the diagnostic indications for EUS use in patients with liver diseases. We performed a MEDLINE\PubMed and Embase search, and all articles that were relevant, after reviewing abstracts, were assessed and the full text was analyzed to extract data regarding technical success, diagnostic yield, bioptic characteristics, and complications rate. EUS-guided imaging and biopsy techniques in liver diseases have shown consistent favorable promising results among the reports through the literature, with an excellent diagnostic yield and safety profile, especially in the context of focal lesions and portal hypertension. The application of EUS in the diagnosis of liver diseases is a promising technique and should be considered as a first-line therapeutic option in selected cases.

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“…38 Few reports on endemic mycoses including coccidioidomycosis and histoplasmosis have been published in this particular setting. [42][43][44][45] Even in endemic areas for coccidioidomycosis, the prevalence of this fungal disease within ESLD patients was less than 5%, exhibiting mainly pulmonary manifestations. Indeed, liver disease is not an established risk factor for the acquisition of endemic mycoses or for its dissemination.…”

Section: The Recent Systematic Review Regarding Sfp Describedmentioning

confidence: 99%

Invasive fungal infections in acute and chronic liver impairment: A systematic review

Lahmer

Peçanha-Pietrobom

Schmid

et al. 2021

Mycoses

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Patients with acute and chronic liver impairment are susceptible to invasive fungal infections such as candidemia and invasive pulmonary aspergillosis as a result of cirrhosis‐associated immune dysfunction, humoral immunodeficiency, cell‐mediated dysfunction and systemic inflammation. Besides classical risk factors for invasive fungal infection, acute‐on‐chronic liver failure, corticosteroid use, gastrointestinal bleeding, and prophylactic use of antibiotics are all additional conditions which are related to the potential development of fungal infections. Therefore, high‐risk patients should be carefully followed by microbiological surveillance including cultures but also by imaging and fungal biomarkers for providing early diagnosis. Echinocandins are still the mainstay and first line antifungal therapy in cases of invasive candidiasis. Due to concerns of liver toxicity and in cases of renal impairment liposomal amphotericin B is a suitable alternative to voriconazole in patients with invasive pulmonary aspergillosis. Although, data of isavucoanzole and posaconazole use in those patients are also promising more specific studies in the subgroup of patients with liver impairment are needed. Especially, due to the late diagnosis and multiple organ dysfunction usually present in patients with liver impairment morbidity and mortality rates remain high. Based on the broad spectrum of diverse reports with varying content and quality and in some cases lack of evidence we performed a systematic review on this topic.

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Impact and safety of endoscopic ultrasound guided fine needle aspiration on patients with cirrhosis and pyrexia of unknown origin in India

Cited by 13 publications

References 17 publications

Evaluating the risk of adverse events with interventional endoscopic retrograde cholangiopancreatography and endoscopic ultrasound procedures in cirrhotic patients

Evaluating the risk of adverse events with interventional endoscopic retrograde cholangiopancreatography and endoscopic ultrasound procedures in cirrhotic patients

A State-of-the-Art Review on the Evolving Utility of Endoscopic Ultrasound in Liver Diseases Diagnosis

Invasive fungal infections in acute and chronic liver impairment: A systematic review

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