Usefulness of endoscopic ultrasound and complication rate in a newly established tertiary care university-affiliated teaching hospital – retrospective analysis of the last 4 years

M Razpotnik; S Bota; G Essler; J Weber-Eibel; M Peck-Radosavljevic

doi:10.1055/s-0039-1691884

Zeitschrift für Gastroenterologie, Table of Contents

Z Gastroenterol 2019; 57(05): e142
DOI: 10.1055/s-0039-1691884

POSTER

Endoskopie

Georg Thieme Verlag KG Stuttgart · New York

Usefulness of endoscopic ultrasound and complication rate in a newly established tertiary care university-affiliated teaching hospital – retrospective analysis of the last 4 years

Authors

M Razpotnik

¹Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
S Bota

¹Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
G Essler

¹Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
J Weber-Eibel

¹Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
M Peck-Radosavljevic

¹Department of Internal Medicine and Gastroenterology (IMuG), Hepatology, Endocrinology, Rheumatology and Nephrology and Emergency Medicine (ZAE) with Centralized Endoscopy Service, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria

Abstract

Full Text

Aim:

To assess the usefulnes of EUS and complication in a newly-established GI-center.

Methods:

Our retrospective study included 565 EUS performed in 470 patients between 2015 – 2018. EUS indications, complication rate and performance for different diagnosis were assessed.

Results:

Overall, interventional EUS rate was 37.1%. The number of EUS significantly increased in 2017 – 2018. The main 3 EUS indications changed over time (Table). Overall, 23 complications in 22/565 (4%)EUS were reported: transient hypoxic respiratory failure: 1.4%, bleeding: 0.8%, pancreatitis: 0.5%, aspiration pneumonia: 0.3%, pancreatic drainage dislocation: 0.3%, pancreatic abscess: 0.1%, sepsis: 0.1% and thrombosis of superior mesenteric vein: 0.1%.

Choledocholithiasis was diagnosed in 36.4% of suspected cases. EUS showed a very good performance: 100% PPV, 97.6% NPV and 98.4% accuracy.

EUS could identify a cause of pancreatitis in 62.5% of cases with initially unknown etiology (45.8% biliary etiology, 8.2% pancreatic tumor and 4.5% pancreaticolithiasis and autoimmunpancreatitis).

EUS-FNA accuracy for solid pancreatic masse was 51.9%, with lowest value in 2016 (27.2%), and highest value in 2018 (79.3%).

Subepithelial tumors were confirmed by EUS in 64.4% of suspected cases. FNA was performed in 35.8% of cases. The rate of conclusive histology was low (20.7%).

An intervention was performed in 69.2% of all pancreatic cysts (53.8% FNA, 9.9% Pigtail drainage and 5.5% AXIOS®drainage).

Tab. 1:

Number of investigations and EUS indications
	2015 (100 EUS)	2016 (73 EUS)	2017 (146 EUS)	2018 (246 EUS)
Nr (%) interventional EUS	n = 41 (41%)	n = 38 (52%)	n = 61 (41.7%)	n = 70 (28.5%)
Endoscop: -radial -linear	n = 0 (0%) n = 100 (100%)	n = 0 (0%) n = 73 (100%)	n = 59 (40.4%) n = 87 (59.6%)	n = 136 (55.3%) n = 110 (44.7%)
Main indications	1. Subepithelial tumors n = 33 (33%) 2. Pancreatic cysts n = 24 (24%) 3. Pancreatic masses n = 22 (22%)	1. Subepithelial tumors n = 27 (36.9%) 2. Pancreatic masses n = 17 (23.2%) 3. Pancreatic cysts n = 10 (13.7%)	1. Subepithelial tumors/Suspicion of choledocolithiasis n = 35 (23.9%)/ n = 35 (23.9%) 3. Pancreatic masses n = 32 (21.9%)	1. Suspicion of choledocolithiasis n = 92 (37.4%) 2. Pancreatic masses n = 46 (18.7%) 3. Subepithelial tumors n = 30 (12.2%)

Conclusion:

EUS is increasingly used in our Center with a low rate of complications and excellent performance for detection of choledocholithiasis and provided an etiology in more than half of patients with unknown cause of acute pancreatitis.