The bleeding risk after endoscopic ultrasound-guided puncture of pancreatic masses

Razpotnik, M; Bota, Simona; Kutilek, Mathilde; Essler, G; Weber-Eibel, J; Maieron, A; Peck‐Radosavljevic, Markus

doi:10.1080/00365521.2020.1863458

Cited by 6 publications

(5 citation statements)

References 18 publications

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“…On the other hand, a study of EUS-guided liver biopsy that included 15.8% cirrhotic patients showed that adverse events were uncommon (1.8%), most of which were self-limited [ 30 ]. However, as shown in our data, it is reasonable to say that liver cirrhosis is a risk factor for an adverse event during EUS-TA, since a low platelet count is common in cirrhotic patients, and thrombocytopenia itself is a well-known risk factor of bleeding during EUS-TA [ 23 ].…”

Section: Discussionmentioning

confidence: 90%

“…However, the safety of novel FNB needles, compared to conventional FNA needles and reverse-bevel needles, has rarely been discussed. A retrospective study in 2021 revealed that the use of FNB needles (most of them Franseen-tip needles and Fork-tip needles) and lower platelet count were two parameters associated with minor bleeding after EUS-TA [ 23 ]. In our multivariate analysis, there is no statistically significant difference between Franseen-tip needles, conventional FNA needles, and reverse-bevel needles regarding adverse events.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Adverse Events of Different Endoscopic Ultrasound-Guided Tissue Acquisition Methods: A Single-Center Retrospective Analysis

et al. 2022

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The efficacy of new generation endoscopic ultrasound-guided biopsy needles has been promising in recent years. Yet, comparing these needles’ diagnostic yield and safety to conventional needles is not well-known. Our study aims to compare the adverse events of endoscopic ultrasound-guided tissue acquisition (EUS-TA) with different types of needles, including FNA needles, FNB needles with a Franseen tip and FNB needles with a reverse bevel. Furthermore, we will analyze the risk factors, including tumor vascularity, different needle types, and the underlying disease, which may impact the safety of the procedures. From May 2014 to December 2021, 192 consecutive EUS-TAs were performed on pancreatic and peripancreatic lesions in our hospital using different types of FNA and FNB needles. We retrospectively reviewed the data and identified the risk factors for EUS-TA-related complications. As a result, the hypervascular tumor is a significant risk factor for adverse events in our multivariate analysis, with an odds ratio of 4.96 (95% CI 1.33–18.47), while liver cirrhosis is one of the risk factors for adverse events during EUS-TA, with an odds ratio of 5.3 (95% CI 1.1–25.6). However, the risk of adverse events did not increase using Franseen-tip needles, compared to conventional FNA or FNB needles with a reverse bevel. In conclusion, we must be more cautious in patients with liver cirrhosis and hypervascular tumors, such as pancreatic neuroendocrine tumors, when performing EUS-guided tissue acquisition.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Comparison of Adverse Events of Different Endoscopic Ultrasound-Guided Tissue Acquisition Methods: A Single-Center Retrospective Analysis

et al. 2022

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“…In a previous study by Razpotnik et al, major bleeding risk during sampling of solid pancreatic masses was 0.7% with minor bleeding reported in up to 15.6%. Bleeding risk was correlated with use of FNB needles 28 . In our systematic review, none of the studies included patients undergoing FNB.…”

Section: Discussionmentioning

confidence: 96%

“…Bleeding risk was correlated with use of FNB needles. 28 In our systematic review, none of the studies included patients undergoing FNB. With increasing change in practice toward use of FNB needles, there is need for more studies looking at transvascular sampling using FNB needles.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Giri

Harindranath

Angadi

et al. 2023

J of Clinical Ultrasound

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Background The diagnosis of intrathoracic and abdominal masses is challenging when lesions are located behind major vessels. Endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS)‐guided transvascular needle aspiration (TVNA) provides a potentially useful diagnostic tool for such lesions. Data with respect to the safety and outcome of E‐TVNA are scarce. Hence, this meta‐analysis was conducted to assess the critical role of E‐TVNA for diagnosis of various lesions. Methods and Material A meta‐analysis was performed by pooling the data from studies obtained from comprehensive search of Medline, Embase, and Scopus from January 2000 to September 2022. The outcomes analyzed included sample adequacy, diagnostic accuracy and adverse events including bleeding. Results A total of 17 studies (n = 411) were included in the final analysis. The pooled rate of sample adequacy was 91.5% [95% confidence interval (CI): 86.8–96.2], while the pooled rate of diagnostic accuracy was 85.0% (95% CI: 78.9–91.2). The pooled rate of bleeding with E‐TVNA was 1.4% (95% CI 0.0–3.1%). All the episodes of bleeding were mild and resolved without any further intervention. There was no significant heterogeneity with respect to various outcomes and results were comparable on sensitivity analysis. Conclusions E‐TVNA offers a safe and accurate diagnostic modality for the diagnosis of mediastinal and abdominal lesions located on the other side of major vessels. Selection of potential candidates and close periprocedural observation are essential to improve the outcome.

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“…The qualitative CH-EUS assessment used in this work is associated with a moderate interobserver agreement for the enhancement and fair for the wash-out) [ 32 ]. The use of EUS-FNB in the case of solid pancreatic masses proved to have better results than EUS-FNA [ 33 ], but their use in the case of PCN can be associated with a higher bleeding rate of up to 8.2% [ 34 ]. At the time of starting this study, anti-biotherapy prophylaxis was indicated, but this attitude is obsolete now [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Utility of the Contrast-Enhanced Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Pancreatic Cyst

et al. 2022

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Endoscopic ultrasound fine needle aspiration (EUS-FNA) cytology from an intracystic fluid is useful in the differentiation of pancreatic cysts, with low sensitivity, which increases when the solid component is targeted. The clinical utility of contrast-enhanced guided EUS-FNA (CH-EUS-FNA) in the solid component is not known. We aimed to assess the diagnostic value of CH-EUS-FNA in enhanced mural nodules and discrimination between different cysts using contrast-enhanced endoscopic ultrasound (CH-EUS). The prospective study recruited patients with pancreatic cysts with an unclear diagnosis. The CH-EUS was followed by CH-EUS-FNA. The final diagnosis was based on surgery or the correlation between clinical history, cross-sectional imaging, echoendoscopic morphology, cystic fluid analysis, and follow-up. Fifty-eight patients with pancreatic cysts were evaluated. The mucinous cysts had wall arterial enhancement more often than non- mucinous cysts (p < 0.0001), with 90.2% sensitivity and 70.6% specificity. The CH-EUS-FNA from cystic fluid and mural nodules identified mucinous cysts and malignancy with 82.4% and 84.2% sensitivity and 92% and 100% specificity. Twenty-one cysts had solid components, but only 13 were enhanced mural nodules on EUS assessment with conclusive cytology in all cases and malignancy in 76.9%. Contrast-enhanced endoscopic ultrasound should be completed in all PCN with solid components in order to avoid unnecessary EUS-FNA and to guide FNA for the identification of malignant cysts.

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The bleeding risk after endoscopic ultrasound-guided puncture of pancreatic masses

Cited by 6 publications

References 18 publications

Comparison of Adverse Events of Different Endoscopic Ultrasound-Guided Tissue Acquisition Methods: A Single-Center Retrospective Analysis

Comparison of Adverse Events of Different Endoscopic Ultrasound-Guided Tissue Acquisition Methods: A Single-Center Retrospective Analysis

Efficacy and safety of endosonography‐guided transvascular needle aspiration of thoracic and abdominal lesions: A systematic review and meta‐analysis

Clinical Utility of the Contrast-Enhanced Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Pancreatic Cyst

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