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

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.