Safety of Fine Needle Aspiration (FNA) during Endoscopic Ultrasound (EUS): A Prospective Study

Background: FNA is commonly performed in conjunction with EUS procedures. There is limited prospective data on complication rates.

Hypothesis: In prospective assessment, FNA is a safe procedure with limited complications in a high volume EUS referral center.

Methods: Approximately 1200 patients undergo EUS at Mayo Clinic Jacksonville on annual basis for different indications. Of those, about 40% will undergo FNA. Between April and October 2005, 230 patients who underwent EUS- FNA were included in this study. These patients were screened for post-procedural complications including abdominal pain, nausea, vomiting, fever, gastrointestinal bleeding and dysphagia. Complications were assessed on day 0 by direct examination and at day 30 by a telephone call... Inquiries were made about emergency room visits or hospitalizations during the same period of time.

Results: Table 1 demonstrates location of FNA for all patients (n=230). Complete follow up information was obtained on 207 patients (90%).

-Day 0: Three patients were admitted to the hospital for observation. Two patients had abdominal pain after pancreatic cyst FNA and one was observed after mediastinal lymph nodes FNA for chest pain. All three patients were discharged within 24 hours of admission. There was no requirement of blood transfusion and no evidence of pancreatitis or infection in any of the hospitalized patients. One patient reported to the ER after EUS-FNA and was sent home on oral analgesics after appropriate evaluation.

-Day 30: Four patients expired during the first month after EUS from primary disease process (3 had pancreatic cancer and one had lung cancer). Five patients were hospitalized for planned elective surgeries during the same period of time. There was no unplanned morbidity or mortality attributable to EUS-FNA.

Conclusion: FNA is a safe intervention in patients undergoing EUS in high volume academic center with post procedural self-limited complication rate of 1%

FNA by Location	n=230
Pancreatic masses and cysts	103
Mediastinal masses and lymphadenopathy	74
Abdominal and pelvic lymphadenopathy	20
Gastroduodenal submucosal masses	8
Liver	7
Rectal	3
Miscellaneous	15

Table 1