Severe acute pancreatitis after EUS-FNA of a pancreatic cyst: a rare, but serious complication

Abstract

As a consequence of improved quality of abdominal imaging techniques in the last decades, discovery of pancreatic cystic lesions has become more common. The clinical significance of these lesions is often unclear and poses a diagnostic dilemma. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a subject of debate regarding its role in the diagnostic evaluation of pancreatic masses and cysts. Although risks associated with the procedure are low, consequences can be serious and even life-threatening. We report a case of a previously healthy 59-year-old woman who suffered severe acute pancreatitis after EUS-FNA of a pancreatic cyst, requiring admission to the intensive care unit (ICU). Development of infected pancreatic necrosis and, successively, bowel ischaemia, led to multiple organ failure. Despite maximal antibiotic and surgical treatment the patient succumbed to refractory septic shock. The fatal outcome of this case illustrates the importance of balanced decision-making in the diagnostic approach of pancreatic cystic lesions.

Assessment of morbidity and mortality associated with endoscopic ultrasound‐guided fine‐needle aspiration for pancreatic cystic lesions: A systematic review and meta‐analysis

“…According to The American Society for Gastrointestinal Endoscopy (ASGE), patients who undergo EUS‐FNA of cystic lesions (pancreatic or mediastinal) are at an increased risk of fever and possibly of infectious adverse events . Reported adverse events of EUS‐FNA for PCL have included acute pancreatitis, hemorrhage, and pancreatic ascites . Although previous studies have evaluated the accuracy of EUS‐FNA in the diagnosis of pancreatic cyst lesions, post‐procedure adverse events are an important concern.…”

Optimization of Endoscopic Ultrasound Characteristics in the Diagnosis of Malignant Intraductal Papillary Mucinous Neoplasm

“…Moreover, these procedures carry a notable risk of pancreatitis and should not be undertaken lightly. 33 Even if these procedures are to be performed, we believe they should be conducted cautiously after carefully assessing malignant findings through minimally invasive tests and thoroughly evaluating the necessity and appropriateness of the examinations. The examinations should be conducted in order of increasing invasiveness, and also considering cost implications, it is recommended to prioritize EUS for the initial procedure over ERCP and EUS-FNA.…”

Contrast–enhanced endoscopic ultrasound diagnosis of the intraductal papillary mucinous neoplasm

“…The collection of cystic fluid by FNA allows to evaluate the CEA levels, cytology, and KRAS/GNAS mutation analyses, improving the diagnostic accuracy of EUS in differentiating malignant from benign PCN [22]. However, FNA is an invasive technique with a relatively low risk of complications, ranging from 0 to 5% [3,5,13,[23][24][25], but rarely may lead to death due to fatal acute pancreatitis [24]. Furthermore, the use of FNA may be limited by some contraindications [6].…”