Diagnostic endoscopic ultrasonography: assessment of safety and prevention of complications

Abstract

Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients' specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.

Keywords: Acute pancreatitis; Bleeding; Complications; Contraindications; Endoscopic ultrasonography; Endoscopic ultrasonography-guided fine-needle biopsy; Infection; Perforation; Risk; Safety.

Figures

Figure 1

Flexibility and rigid tip of echoendoscopes and standard videoendoscopes. A: Longitudinal video-echoendoscope EG-3870 UTK (left; Pentax Medical/Hitachi Medical Systems; angulation up/down 130/130 degrees) with an approximately 50-mm long rigid tip at the distal end (diameter 12.8 mm). The therapeutic video-duodenoscope ED-3490 TK from the same manufacturer (right; Pentax Medical; distal outer diameter 11.6 mm, angulation up/down 120/90 degrees); B: Radial video-echoendoscope EG-3670 URK (left; Pentax Medical/ Hitachi Medical Systems; angulation up/down 130/60 degrees) with an approximately 50-mm long rigid tip at the distal end (diameter 12.1 mm) and the standard video-gastroscope EG-2990i from the same manufacturer (right: Pentax Medical; distal outer diameter 9.8 mm, angulation up/down 210/120 degrees).

Figure 2

Intraluminal bleeding after endoscopic ultrasonography-guided fine-needle aspiration. Marked intraluminal bleeding occurred following 19 G endoscopic ultrasonography-guided fine-needle aspiration of a large, hypervascularized gastrointestinal stromal tumor in the stomach. Hemorrhage stopped without intervention.

Figure 3

Extraluminal bleeding from needle track following endoscopic ultrasonography-guided fine-needle aspiration. Hemorrhage occurred immediately after endoscopic ultrasonography-guided fine-needle aspiration (22 Gauge) of a splenic metastasis (M) of gastric cancer. A: Note blood flow within needle track (arrows), which extends beyond the splenic capsule (arrowhead); B: Bleeding ceased spontaneously approximately 3 min later (no detectable flow within the needle track; arrows).