Ultraschall Med 2013; 34 - WS_SL8_02
DOI: 10.1055/s-0033-1354849

Spectrum and complications of percutaneous ultrasound guided intraabdominal interventions – results of the prospective multicenter DEGUM study

D Strobel 1, T Mueller 2, A Reichel 3, M Wuestner 4, V Keim 5, D Schacherer 6, AP Barreiros 7, G Kunze 8, D Nuernberg 9, A Ignee 10, E Burmester 11, A Bunk 12, M Friedrich-Rust 13, E Fröhlich 14, A Schuler 15, C Jenssen 16, W Bohle 17, M Mauch 18, K Dirks 19, J Kämmer 20, C Pachmann 21, J Stock 22, M Hocke 23, A Kendel 24, C Schmidt 25, C Jakobeit 26, W Heinz 27, K Kinkel 28, G Hübner 29, M Pichler 30, T Bernatik 31
  • 1Erlangen University Hospital, Internal Medicine 1, Erlangen, Germany
  • 2Klinikum am Steinenberg, Reutlingen, Germany
  • 3SRH Waldklinikum, Gera, Germany
  • 4Brüderkrankenhaus, Trier, Germany
  • 5University Leipzig, Internal medicine, Leipzig, Germany
  • 6University Hospital Regensburg, Internal Medicine, Regensburg, Germany
  • 7University Hospital, Mainz, Germany
  • 8Krankenhaus, Villingen-Schwenningen, Germany
  • 9Ruppiner Kliniken, Neuruppin, Germany
  • 10Caritas Krankenhaus, Bad Mergentheim, Germany
  • 11Sana Klinikum, Lübeck, Germany
  • 12University Hospital Dresden, Surgery, Dresden, Germany
  • 13University Hospital Frankfurt a.M., Internal Medicine, Frankfurt am Main, Germany
  • 14Karl-Olga-Krankenhaus, Stuttgart, Germany
  • 15Helfenstein Klinik, Geislingen, Germany
  • 16Krankenhaus Märkisch-Oderland GmbH, Strausberg, Germany
  • 17Katharinenhospital, Klinikum, Stuttgart, Germany
  • 18Kliniken Landkreis, Sigmaringen, Germany
  • 19Krhs. Bad Cannstatt, Stuttgart, Germany
  • 20St. Hedwig-KH, Berlin, Germany
  • 21Israelitisches Krankenhaus, Hamburg, Germany
  • 22Vivantes Humboldt-Klinikum, Berlin, Germany
  • 23Klinikum Meiningen GmbH, Meiningen, Germany
  • 24Kreiskrankenhaus, Gummersbach, Germany
  • 25Albertinenkrankenhaus, Hamburg, Germany
  • 26Helios Kliniken, Bochum, Germany
  • 27Klinikverbund Südwest, Leonberg, Germany
  • 28Krankenhaus, Düren, Germany
  • 29Krankenhaus Köthen GmbH, Köthen, Germany
  • 30Klinium Innenstadt, München, Germany
  • 31Kreisklinik, Ebersberg, Germany

Purpose: To analyse the current spectrum and potential complications of ultrasound guided abdominal interventions a prospective multicenter analysis was performed (DEGUM intervention trial).

Material and methods: Within a time period of 2.5 years diagnostic and therapeutical intraabdominal interventions (with the exclusion of ascites paracentesis) performed percutaneously under continuous ultrasound guidance were analysed. Number and type of intervention, operator experience, patient characteristics, medication, lab data as well as technical aspects of the procedure and potential complications were prospectively assessed using a pseudonymized standardized web site entry form.

Results: 8172 sonographic guided interventions in the abdomen (liver n = 5903; pancreas n = 501, kidney n = 434, lymph node = 272, biliary n = 129, spleen n = 63, other abdominal organs n = 231, extra-organic targets n = 63) were assessed in 30 hospitals. The majority of punctures were diagnostic biopsies including 1780 liver parenchyma, 3400 focal liver lesions and 404 pancreatic lesions. 7525 interventions (92.1%) were performed in hospitalized patients (mean age 62.56 years, range 11 – 97 years). Most operators (predominantly DEGUM 2 and DEGUM 3 level) were highly experienced in ultrasound guided interventions (> 500 interventions prior to the study n = 5729; 70.1%). Analgosedation was given to 1131 patients (13.8%). Needle diameter was > 1 mm in 7112 interventions (87.0%) with main focus on 18 Gauge needles (n = 4185). Fine needles </= 1 mm were used in 1060 punctures (13%). Clinically relevant bleeding complications with need of transfusion (0.4%), surgical bleeding control (0.1%) or radiological coiling (0.06%) were rare.

Conclusion: The spectrum of ultrasound guided abdominal interventions is broad, however diagnostic liver biopsies dominate the number of interventions with the use of 18 Gauge needles. Most biopsies are performed in hospitalized patients using local anaesthesia only. Overall, sonographic guided interventions are save and have low complication rates.