The safety of fine-needle aspiration guided by endoscopic ultrasound

I have read the article by Al-Haddad et al. with great interest and am impressed by their data on safety in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) [1]. In the discussion section they provide a table covering the results from their study as well as from eight other previously published studies on EUS-FNA safety. The number of included patients ranges from 42 to 483, with variable inclusion criteria and outcomes. In 2005 my colleagues and I published our single-center safety experience with EUS in 3324 consecutive patients of whom 670 had EUS-FNA [2]. EUS-FNA related complications were seen in 0.3 % (2/670) of the patients which compares favorably with the data reported by Al-Haddad et al. To our surprise we did not detect any significant difference between the complication rates for EUS alone and EUS-FNA, but in contrast to Al-Haddad et al. we had to classify 90 % (9/10) of the complications as severe and 20 % (2/10) as fatal. This may be explained by the reported different rates regarding the indications for EUS-FNA, and I believe that the variation in morbidity and mortality rates related to EUS-FNA (and EUS alone) mirrors the populations and indications included rather than the experience of the endosonographer(s). Thus, I fully agree with the conclusion by Al-Haddad et al. regarding the safety of EUS-FNA, but the reported differences may simply reflect different populations and indication patterns.

Competing interests: None.

References

• 1 Al-Haddad M, Wallace M B, Woodward T A. et al . The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study.  Endoscopy. 2008;  40 204-208
• 2 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