Assessment of EUS and EUS-Guided FNA Complications in a Large Cohort of Patients

Background: Endoscopic ultrasound (EUS) and EUS-guided fine needle aspiration (FNA) have emerged as accurate and safe methods for the diagnosis and staging of many different gastrointestinal and non-gastrointestinal diseases. Due to the use of special equipments, with unique optical and mechanical properties, the incidence and types of complications of EUS may differ from those seen in other endoscopic explorations. The performance of EUS-FNA may increase the complication risk. Aim: To evaluate the morbimortality associated to EUS and EUS-guided FNA. Methods: Consecutive patients referred to our EUS Unit between January 2003 and October 2005 were evaluated. EUS was performed either by the lineal scanning Pentax FG-38UX or by radial scanning Pentax EG-3630UR. EUS-guided FNA was performed by using 19G and 22G needles (Sonotip II, Mediglobe®). EUS explorations were performed by three echoendoscopists. All procedures were performed under conscious sedation with midazolam and meperidine. Vital signs were continuously monitored. A descriptive analysis of major complications of EUS and EUS-FNA was made. Major complications were defined as the development of perforation, bleeding, sepsis, pancreatitis, peritonitis or respiratory insufficiency related to the procedure and leading to prolonged length of hospital staying. Results: A total of 1073 EUS patients (630 male, 443 female, mean age 56 years, range 17–87 years) were explored over the study period. The radial and linear echoendoscopes were used in 332 (30.9%) and 723 (67.4%) cases, respectively. Both equipments were used in 18 patients (1.7%). EUS-guided FNA was performed in 159 cases (15%). In total, only 4 major complications were described (0.37%). Acute respiratory insufficiency requiring oxygen therapy was developed after diagnostic radial EUS (0.09%) in a patient with chronic obstructive pulmonary disease. Three complications (1.89% of the FNA performed) were clearly related to EUS-guided FNA: A pneumothorax was developed in a patient after puncture of a mediastinal mass, and a gastric bleeding requiring endoscopic haemostasia and a mild acute pancreatitis were developed after FNA of pancreatic masses. No procedure-related death was recorded. Conclusion: EUS and EUS-guided FNA are safe and minimally invasive procedures, with a very low complication rate and no mortality.