Early Morbidity of Endoscopic Ultrasound: 13 Years’ Experience at a Referral Center

Background and Study Aim: Endoscopic ultrasonography (EUS) now has an important place in the diagnosis of gastroenteropancreatic diseases. However, prospective data on the morbidity and mortality related to its use are sparse and often retrospective. We attempted to assess the acute and immediate complications of both diagnostic and interventional EUS.
Patients and Methods: At our university-affiliated tertiary care referral center, immediate (occurring during the procedure) and acute (occurring within 24 hours) complications of EUS were prospectively investigated. Over a first period, spanning 10 years, complications of diagnostic EUS involving 3207 consecutive patients were assessed. During the second period of 3 years, complications observed after EUS-guided fine-needle aspiration (FNA) biopsy were evaluated from 224 procedures. EUS was mostly done with the patient under sedation with intravenous propofol and spontaneous ventilation, and complications were evaluated by both the operator and the anesthesiologist.

Results: There were no deaths, and no surgery was required over the two periods of assessment. Three mild complications occurred among patients who underwent standard diagnostic EUS: two immediate complications were related to anesthesia and one to the procedure. There were five complications associated with interventional EUS; all were related to the procedure (acute pancreatitis, duodenal perforation, upper digestive bleeding, cyst, and mediastinal infection), with a mean delay of occurrence of 30 hours, and mean duration of hospitalization of 7 days.
Conclusion: In our experience, which is the longest reported in Europe, the morbidity rates of diagnostic EUS and EUS-guided FNA biopsy were 0.093 % and 2.2 %, respectively, with no mortality.

References

• 1 Buscail L. Endoscopic ultrasonography in pancreatobiliary disease using radial instruments. In: Rösch T (ed) Endoscopic ultrasonography: state of the art 1995, part II. Gastrointest Endosc Clin N Am 1995 5: 781-787
• 2 Buscail L, Pagès P, Berthélemy P. et al . Role of endoscopic ultrasonography in the management of pancreatic and ampullary carcinoma: a prospective study assessing resectability and prognosis.  Gastrointest Endosc. 1999;  50 34-40
• 3 Hawes R H. Endoscopic ultrasound.  Gastrointest Endosc Clin N Am. 2000;  10 161-174
• 4 Giovanini M, Seitz J F, Monges G. et al . Fine needle aspiration guided by endosonography ultrasound: results in 141 patients.  Endoscopy. 1995;  27 171-177
• 5 Wiersema M J, Vilmann P, Giovanini M. et al . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 1087-1095
• 6 Voss M, Hammel P, Molas G. et al . Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses.  Gut. 2000;  46 244-249
• 7 Gress F, Hawes R H, Savides T J. et al . Endoscopic ultrasound-guided fine needle aspiration biopsy using linear array and radial scanning endosonography.  Gastrointest Endosc. 1997;  45 243-250
• 8 Levy M J, Wiersema M J. EUS-guided celiac plexus neurolysis and celiac plexus block.  Gastrointest Endosc. 2003;  57 923-930
• 9 Schmulewitz N, Hawes R. EUS-guided celiac plexus neurolysis - technique and indication.  Endoscopy. 2003;  35 S49-S53
• 10 Allescher H D, Rosch T, Willkomm G. et al . Performance, patient acceptance, appropriateness of indications and potential influence on outcome of EUS: a prospective study in 397 consecutive patients.  Gastrointest Endosc. 1999;  50 737-745
• 11 Rosch T, Allescher H D. Update in gastroenterologic endoscopy. A review of endoscopy abstracts presented at the 1993 DDW in Boston.  Endoscopy. 1993;  25 401-422
• 12 Das A, Sivak M V Jr, Chak A. Cervical esophageal perforation during EUS: a national survey.  Gastrointest Endosc. 2001;  53 599-602
• 13 Palazzo L, Canard J M, Carayon P. et al . L’écho-endoscopie en France en 1998: résultats d’une enquête prospective de la Société Française d’Endoscopie Digestive.  Gastroenterol Clin Biol. 1999;  23 A42
• 14 Denis B, Ben Abdelghani M, Peter A. et al . Deux années de réunions de mortalité et de morbidité dans l’unité hospitalière d’endoscopie digestive.  Gastroenterol Clin Biol. 2003;  27 1100-1104
• 15 O’Toole D, Palazzo L, Arotçarena R. et al . Assessment of complications of EUS-guided fine-needle aspiration.  Gastrointest Endosc. 2001;  53 470-474
• 16 Gress F, Michael H, Gelrud D. et al . EUS-guided fine needle aspiration of the pancreas: evaluation of pancreatitis as a complication.  Gastrointest Endosc. 2002;  5 864-867
• 17 Mortensen M B, Fristrup C, Holm F S. et al . Prospective evaluation of patient tolerability, satisfaction with patient information, and complications in endoscopic ultrasonography.  Endoscopy. 2005;  37 146-153
• 18 Lapalus M G, Saurin J C. Complications de l’endoscopie digestive: gastroscopie et coloscopie.  Gastroenterol Clin Biol. 2003;  27 909-921
• 19 Canard J M, Carayon P, Dumas R. L’endoscopie oeso-gastroduodénale en France en 1998: résultats d’une enquête prospective nationale de la Société Française d’Endoscopie Digestive.  Gastroenterol Clin Biol. 1999;  23 A41
• 20 Arrowsmith J B, Gerstman B B, Fleischer D E, Benjamin S B. Results from the American Society for Gastriointestinal Endoscopy/U. S. Food and Drugs Administration collaborative study on complication rates and drug use during gastrointestinal endoscopy.  Gastrointest Endosc. 1991;  37 421-427
• 21 Bell G D. Preparation, premedication, and surveillance.  Endoscopy. 2004;  36 23-31
• 22 Eloubeidi M A, Chen V K, Eltoum I A. et al . Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications.  Am J Gastroenterol. 2003;  98 2663-2668
• 23 Barawi K, Gottlieb K, Cunha B. et al . A prospective evaluation of the incidence of bacteremia associated with EUS-guided fine needle aspiration.  Gastrointest Endosc. 2001;  53 189-192
• 24 Levy M J, Norton I D, Wiersema M J. et al . Prospective risk assessment of bacteremia and other infectious complications in patients undergoing EUS-guided FNA.  Gastrointest Endosc. 2003;  57 672-678
• 25 Janssen J, Konig K, Knop-Hammad V. et al . Frequency of bacteremia after linear EUS of the upper GI tract with and without FNA.  Gastrointest Endosc. 2004;  59 339-344
• 26 Affi A, Vazquez-Sequeiros E, Norton I D. et al . Acute extraluminal hemorrhage associated with EUS-guided fine needle aspiration: Frequency and clinical significance.  Gastrointest Endosc. 2001;  53 221-225