title: Acute extraluminal hemorrhage associated with EUS-guided fine needle aspiration: frequency and clinical significance.
abstract: BACKGROUND
  Complications with EUS-guided fine needle aspiration cytology (EUS-guided FNA) are rare and include perforation, infection, pancreatitis, and intraluminal bleeding. To date, the ultrasound appearance and clinical significance of perilesional bleeding during EUS-guided FNA have not been described. The aim of this study was to analyze the frequency of acute extraluminal hemorrhage associated with EUS-guided FNA.
  
  
  METHODS
  From September 1998 to October 1999 EUS-guided FNA was performed during 227 of 1104 EUS procedures. Patient follow-up and complications were recorded and retrospectively analyzed.
  
  
  METHODS
  Three patients were identified with acute extraluminal hemorrhage at the site of the aspiration during EUS (frequency 1.3%: 95% CI [0%, 2.8%]). The bleeding manifested as an expanding echopoor region adjacent to the sampled lesion. No clinically recognizable sequela arose from the bleeding. All patients were treated with a short course of antibiotics and outpatient observation. Preprocedure coagulation and platelet assessment did not predict which patients were at risk for this complication.
  
  
  CONCLUSIONS
  Acute extraluminal hemorrhage occurring during EUS-guided FNA is a rare complication with a characteristic ultrasound appearance. Recognition of this event might be important to allow the endoscopist to terminate the procedure and thereby minimize the potential for more serious bleeding.
authors.affiliation: Developmental Endoscopy Unit, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: A
authors.initials: A
authors.lastname: Affi
authors.forename: E
authors.initials: E
authors.lastname: Vazquez-Sequeiros
authors.forename: I D
authors.initials: ID
authors.lastname: Norton
authors.forename: J E
authors.initials: JE
authors.lastname: Clain
authors.forename: M J
authors.initials: MJ
authors.lastname: Wiersema
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D019160:Endosonography; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies