Background and aims: Like FNA, the close proximity of the tip of the echoendoscope to the target organ permits therapeutic procedures. Procedures like celiac plexus neurolysis (CPN), pseudocyst/abscesses drainage, and pancreatic and biliary ductal system drainages have been introduced into clinical practice. Nevertheless, complications related to interventional EUS have not been assessed in prospective studies. To assess in a prospective, multicenter study the complication rates of interventional EUS (FNA and therapeutic procedures performed under EUS guidance). We report preliminary data through 9 months. Methods: Data between Jan 2010 and Oct 2010 were collected from four referral centers, searching for all complications (e.g., hemorrhage, acute pancreatitis, intestinal perforation) related to interventional EUS (EUS FNA, pseudocyst/ abscess drainage, biliary-pancreatic drainage, CPN). All patients signed an informed consent. Demographics, comorbidities, drug history, and laboratory tests were collected. Vital signs were monitored during procedures. The procedures were performed under deep sedation or general anesthesia by experienced endosonographers. Antibiotic prophylaxis was performed when indicated. Early and late complications (mild, moderate, severe, fatal) were recorded during follow-up. Results: Three hundred fifteen (315) interventional EUS were performed over 10 months (mean follow-up 164.4 days) in 173 males/ 142 females (mean age 63.4 13.9): 293 EUS-FNA, 14 CPN, 7 pseudocyst/abscess drainage, and 1 biliary drainage. The overall complication rate was 3.5%. Complications were: 2 diarrhea (post-CPN), 1 epigastric pain (post-FNA), 2 intracystic hemorrhages, and 1 gastric bleeding (post-FNA), 5 fever (4 post-FNA, 1 post-pseudocyst drainage). FNA was associated with a lower risk of complications (p0.007,OR 0.18, 95% CI 0.4-0.7). Nevertheless, FNA on cystic lesions was associated with a higher risk of complications than that on solid ones (p0.001, OR 15.2, 95% CI 2.9-77.6). All events occurred within 10 days, and all but one (moderate) were mild and resolved with medical therapy. No deaths occurred. Conclusions: Our preliminary results show that EUS-FNA is safer than other EUS-guided procedures, even if all interventional procedures are associated with a low rate of complications. We aim to collect more than 1,000 cases, and to analyze the potential associated risk factors
Tarantino, I., Fabbri, C., Muscatiello, N., Pagano, N., Di Mitri, R., Barresi, L., et al. (2011). PROSPECTIVE MULTICENTER STUDY OF INTERVENTIONAL ENDOSCOPIC ULTRASOUND (IEUS) COMPLICATIONS. DIGESTIVE AND LIVER DISEASE, 43, S172-S172 [10.1016/S1590-8658(11)60299-5].
PROSPECTIVE MULTICENTER STUDY OF INTERVENTIONAL ENDOSCOPIC ULTRASOUND (IEUS) COMPLICATIONS
Tarantino, I;Fabbri, C;Mocciaro, F;Traina, M
2011
Abstract
Background and aims: Like FNA, the close proximity of the tip of the echoendoscope to the target organ permits therapeutic procedures. Procedures like celiac plexus neurolysis (CPN), pseudocyst/abscesses drainage, and pancreatic and biliary ductal system drainages have been introduced into clinical practice. Nevertheless, complications related to interventional EUS have not been assessed in prospective studies. To assess in a prospective, multicenter study the complication rates of interventional EUS (FNA and therapeutic procedures performed under EUS guidance). We report preliminary data through 9 months. Methods: Data between Jan 2010 and Oct 2010 were collected from four referral centers, searching for all complications (e.g., hemorrhage, acute pancreatitis, intestinal perforation) related to interventional EUS (EUS FNA, pseudocyst/ abscess drainage, biliary-pancreatic drainage, CPN). All patients signed an informed consent. Demographics, comorbidities, drug history, and laboratory tests were collected. Vital signs were monitored during procedures. The procedures were performed under deep sedation or general anesthesia by experienced endosonographers. Antibiotic prophylaxis was performed when indicated. Early and late complications (mild, moderate, severe, fatal) were recorded during follow-up. Results: Three hundred fifteen (315) interventional EUS were performed over 10 months (mean follow-up 164.4 days) in 173 males/ 142 females (mean age 63.4 13.9): 293 EUS-FNA, 14 CPN, 7 pseudocyst/abscess drainage, and 1 biliary drainage. The overall complication rate was 3.5%. Complications were: 2 diarrhea (post-CPN), 1 epigastric pain (post-FNA), 2 intracystic hemorrhages, and 1 gastric bleeding (post-FNA), 5 fever (4 post-FNA, 1 post-pseudocyst drainage). FNA was associated with a lower risk of complications (p0.007,OR 0.18, 95% CI 0.4-0.7). Nevertheless, FNA on cystic lesions was associated with a higher risk of complications than that on solid ones (p0.001, OR 15.2, 95% CI 2.9-77.6). All events occurred within 10 days, and all but one (moderate) were mild and resolved with medical therapy. No deaths occurred. Conclusions: Our preliminary results show that EUS-FNA is safer than other EUS-guided procedures, even if all interventional procedures are associated with a low rate of complications. We aim to collect more than 1,000 cases, and to analyze the potential associated risk factorsI documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
