Hyperamylasemia after Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) of pancreatic lesions: incidence and clinical impact

Background: Acute pancreatitis as a complication of EUS-FNA of pancreatic lesions is rarely observed. However, there is no information about the incidence of hyperamylasemia and to assess its clinical impact. Aim: To evaluate the incidence of hyperamylasemia after EUS-FNA of pancreatic lesion and its clinical impact. Patients and methods: Patients who underwent an EUS-FNA of a pancreatic lesion between october 2004 and october 2005 were prospectively included. Exclusion criteria were: 1. Platelet count under 50,000 and/or protrombine time <50%; 2. Surgery, ERCP or another invasive procedure seven days prior to EUS-FNA; 3. Not informed consent. Procedures were carried out with the patient under conscious sedation. A radial echoendoscope (Olympus GF-UM160), linear echoendoscope for FNA (Olympus UCT-140) and a 22 G needle (Wilson-Cook) were used. An on site cytologist evaluated the EUS-FNA samples at the time of the procedure. Patients were treated with antibiotic when cystic lesions were found. Serum amylasa levels were determinated before, and 8 and 24 hours after the procedure. Hyperamylasemia was defined as amylasa levels 8 hours after the procedure >104 UI/L (and higher than baseline levels). Results: A total of 100 patients underwent EUS-FNA of pancreatic lesions (58 m/42 w, mean age 60 + 14 y). Main indications were diagnosis of a pancreatic mass (66 cases, 66%) and pancreatic cysts (24 cases; 24%) and the FNA was performed from the duodenum (53 cases, 53%) or the stomach (47 cases, 47%). Mean number of passes was 2 + 1. Twelve patients (12%) showed hyperamylasemia at 8 hours after puncture (288 + 283 UI/Ll, range 105–1044), and two of them developed acute pancreatitis after EUS-FNA defined using clasical criteria. Hyperamylasemia was not related to the type of lesion (cystic or solid), its location, the duration of the procedure or the number of passes. There was no relationship between baseline amylasa levels and the development of hyperamylasemia after EUS-FNA. Conclusions: 1.- The incidence of hyperamylasemia after pancreatic EUS-FNA is low and has no clinical impact in the majority of cases. 2.- EUS-FNA of the pancreas is a safe procedure.