Incidence and clinical significance of hyperamylasemia after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions: a prospective and controlled study

G. Fernández-Esparrach; A. Ginès; P. García; M. Pellisé; M. Solé; P. Cortés; A. Z. Gimeno-García; O. Sendino; S. Navarro; J. Llach; J. M. Bordas; A. Castells

doi:10.1055/s-2007-966719

Endoscopy 2007; 39(8): 720-724
DOI: 10.1055/s-2007-966719

Original article

Incidence and clinical significance of hyperamylasemia after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions: a prospective and controlled study

G. Fernández-Esparrach¹ , A. Ginès¹ , P. García¹ , M. Pellisé¹ , M. Solé² , P. Cortés¹ , A. Z. Gimeno-García¹ , O. Sendino¹ , S. Navarro¹ , J. Llach¹ , J. M. Bordas¹ , A. Castells¹

¹Endoscopy Unit, Institut de Malalties Digestives, Hospital Clinic, CIBER_EHD, University of Barcelona, Spain
²Pathology Department, Hospital Clinic, University of Barcelona, Spain

Abstract

Background and study aim: Acute pancreatitis as a complication of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions is rarely observed. However, there is little information on the incidence of hyperamylasemia after EUS-FNA of the pancreas and its clinical significance. This study aimed to supply this lack of information.

Patients and methods: Patients who underwent EUS-FNA of a pancreatic lesion between October 2004 and October 2005 were studied prospectively. Exclusion criteria were: (i) platelet count under 50 000/mm³ and/or prothrombin time < 50 %; (ii) performance of surgery, endoscopic retrograde cholangiopancreatography (ERCP), a percutaneous biopsy attempt, or another invasive procedure within 7 days before EUS-FNA; (iii) lack of informed consent. Serum amylase levels were determined before and 8 and 24 h after the procedure. Hyperamylasemia was defined by amylase levels above 104 UI/L (and higher than baseline levels) 8 h after the procedure. Acute pancreatitis was defined by upper abdominal pain (with or without nausea and/or vomiting) accompanied by elevation of serum amylase or lipase to at least twice baseline levels.

Results: A total of 100 patients underwent EUS-FNA of a pancreatic lesion (58 men, 42 women; mean age 60 ± 13 years). Eleven patients (11 %) showed hyperamylasemia 8 h after the puncture (298 ± 293 UI/L, range 105 - 1044 UI/L), but only two of them developed acute mild pancreatitis after EUS-FNA. Hyperamylasemia was not related either to the type of lesion (cystic or solid) or to its location, the duration of the procedure, or the number of passes performed.

Conclusions: Pancreatitis after pancreatic EUS-FNA occurs in 2 % of patients, with some more cases of silent hyperamylasemia. This complication may have to be included in the information given to patients for their informed consent.

Full Text

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À. Ginès, MD, PhD

Endoscopy Unit
Institut de Malalties Digestives
Hospital Clinic

Villarroel 170
08036 Barcelona
Spain

Fax: +34-93-2279387

Email: magines@clinic.ub.es