The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study

Background and study aims: Fine-needle aspiration (FNA) is commonly performed in conjunction with endoscopic ultrasound (EUS) procedures. The complication rate associated with FNA is considered to be low but requires further evaluation with prospective studies.

Patients and methods: A total of 483 consecutive patients who underwent EUS-guided FNA over a 12-month period were prospectively enrolled in the study. The patients were screened for postprocedural complications, including abdominal pain, nausea, vomiting, and gastrointestinal bleeding. Complications were assessed immediately after EUS-FNA and 30 days later with a telephone call, when inquiries were made about emergency room and physician’s office visits or hospitalizations during this 30-day period.

Results: Complete information was obtained from 414 patients (86 %). Complications occurred in seven patients during the first day. Five of these patients had unplanned admissions to hospital: two patients were observed because they had abdominal pain after FNA of pancreatic cysts; one patient was observed because they developed chest pain after mediastinal lymph node FNA; and two patients were monitored after celiac node FNA, one with a transient fever and one with self-limited melena. All five of these patients were discharged within 24 hours of admission, none required blood transfusion, and none showed any evidence of pancreatitis or infection. Two other patients visited the emergency department but were discharged on oral analgesics after appropriate evaluation. By day 30 six patients had died as a result of their primary disease process. There was no unexpected morbidity or mortality attributable to the EUS-FNA.

Conclusions: FNA is a safe intervention in patients undergoing EUS in a high-volume academic center, with a low postprocedural complication rate.

References

• 1 Hawes R H. Endoscopic ultrasound.  Gastrointest Endosc Clin N Am. 2000;  10 161-174, viii
• 2 Gress F G, 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
• 3 Giovannini M, Seitz J F, Monges G. et al . Fine-needle aspiration cytology guided by endoscopic ultrasonography: results in 141 patients.  Endoscopy. 1995;  27 171-177
• 4 Cotton P B. Outcomes of endoscopy procedures: struggling towards definitions.  Gastrointest Endosc. 1994;  40 514-518
• 5 Cotton P B, Lehman G, Vennes J. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus.  Gastrointest Endosc. 1991;  37 383-393
• 6 Lee L S, Saltzman J R, Bounds B C. et al . EUS-guided fine-needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors.  Clin Gastroenterol Hepatol. 2005;  3 231-236
• 7 Matsui M, Goto H, Niwa Y. et al . Preliminary results of fine-needle aspiration biopsy histology in upper gastrointestinal submucosal tumors.  Endoscopy. 1998;  30 750-755
• 8 Wiersema M J, Vilmann P, Giovannini M. et al . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.  Gastroenterology. 1997;  112 1087-1095
• 9 Harewood G C, Wiersema M J. Endosonography-guided fine-needle aspiration biopsy in the evaluation of pancreatic masses.  Am J Gastroenterol. 2002;  97 1386-1391
• 10 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;  56 864-867
• 11 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
• 12 Chen V K, Eloubeidi M A. Endoscopic ultrasound-guided fine-needle aspiration of intramural and extraintestinal mass lesions: diagnostic accuracy, complication assessment, and impact on management.  Endoscopy. 2005;  37 984-989
• 13 Schwartz D A, Harewood G C, Wiersema M J. EUS for rectal disease.  Gastrointest Endosc. 2002;  56 100-109
• 14 Adler D G, Jacobson B C, Davila R E. et al . ASGE guideline: complications of EUS.  Gastrointest Endosc. 2005;  61 8-12
• 15 Williams D B, Sahai A V, Aabakken L. et al . Endoscopic ultrasound-guided fine-needle aspiration biopsy: a large single center experience.  Gut. 1999;  44 720-726
• 16 O’Toole D, Palazzo L, Arotcarena R. et al . Assessment of complications of EUS-guided fine-needle aspiration.  Gastrointest Endosc. 2001;  53 470-474