Endoscopy 2020; 52(S 01): S312
DOI: 10.1055/s-0040-1705004
ESGE Days 2020 ePoster presentations
Thursday, April 23, 2020 09:00 – 17:00 Endoscopic ultrasound ePoster area
© Georg Thieme Verlag KG Stuttgart · New York

SAFETY OF EUS FOR PANCREATOBILIARY LESIONS IN PATIENTS IN CIRRHOSIS

CR Simons-Linares
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, United States of America
,
P Palacios
2   John H. Stroger Hospital of Cook County, Internal Medicine, Chicago, United States of America
,
M Salazar
2   John H. Stroger Hospital of Cook County, Internal Medicine, Chicago, United States of America
,
MA Saleh
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, United States of America
,
H Siddiki
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, United States of America
,
A Bhatt
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, United States of America
,
T Stevens
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, United States of America
,
S Jang
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, United States of America
,
J Vargo
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, United States of America
,
P Chahal
1   Cleveland Clinic, Gastroenterology and Hepatology, Cleveland, United States of America
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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    Aims We aim to investigate the safety and adverse events of EUS with FNA and/or FNB in cirrhotics

    Methods Case control study using the 2016 National Inpatient Sample (NIS) using ICD10-CM codes to identify patients who underwent EUS with and without FNA or FNB for pancreatobiliary solid lesions (PBSL). We compared cirrhotics with non-cirrhotic controls. Primary outcome was rate of procedural complications. Subgroup analysis to compare compensated and decompensated cirrhosis as per validated BAVENO VI classification.

    Results A total of 9,731 EUS were performed in 2016 out of which 4% (n = 404) patients were cirrhotics. Of these, 41% (n = 169) had decompensated cirrhosis (BAVENO 3–4). 27% (n = 110) of cirrhotics underwent EUS with either FNA or FNB for PBSL. Non-cirrhotics were more likely to undergo EUS with FNA/FNB for a biliary malignancy when compared to other indications (29.2% vs. 9.1%; p = 0.02). Decompensated cirrhotics had higher rates of ascites (45.4% vs. 10.2%; p < 0.01). EUS with and without FNA/FNB was safe among compensated cirrhotics. However, decompensated cirrhotics were three times more likely to have immediate procedural complications (aOR 3.2; p < 0.01), more likely to have post-EUS perforation (aOR 74.1; p < 0.01), higher mortality (aOR 2.7; p < 0.01), post-procedural SBP (aOR 17.6; p < 0.01) and sepsis (aOR 4.6; p < 0.01), longer hospital LOS (10.7 vs. 7.6 days), higher total healthcare charges ($47,940; p < 0.01), higher total hospital cost ($9,356; p < 0.01).

    Conclusions Decompensated cirrhosis a risk factor for post-procedural complications leading to higher mortality and poor outcomes. Purportedly, it is due to the presence of ascites that predispose to infection, SBP and sepsis rather than coagulopathy and bleeding. Guidelines do not recommend antibiotics for EUS FNA/FNB of PBSL, however our study suggest that a short course of peri-procedure antibiotics may be considered to improve outcomes of decompensated cirrhotics undergoing EUS with FNA/FNB for PBSL


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