Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States.
BACKGROUND
The aim of this study was to determine the frequency and the severity of pancreatitis after EUS-guided FNA of solid pancreatic masses. A survey of centers that offer training in EUS in the United States was conducted.


METHODS
A list of centers in which training in EUS is offered was obtained from the Web site of the American Society for Gastrointestinal Endoscopy. Designated program directors were contacted via e-mail. The information requested included the number of EUS-guided FNA procedures performed for solid pancreatic masses, the number of cases of post-procedure pancreatitis, and the method for tracking complications. For each episode of pancreatitis, technical details were obtained about the procedure, including the location of the mass, the type of fine needle used, the number of needle passes, and the nature of the lesion.


RESULTS
Nineteen of the 27 programs contacted returned the questionnaire (70%). In total, 4909 EUS-guided FNAs of solid pancreatic masses were performed in these 19 centers over a mean of 4 years (range 11 months to 9 years). Pancreatitis occurred after 14 (0.29%): 95% CI[0.16, 0.48] procedures. At two centers in which data on complications were prospectively collected, the frequency of acute pancreatitis was 0.64%, suggesting that the frequency of pancreatitis in the retrospective cohort (0.26%) was under-reported (p=0.22). The odds that cases of pancreatitis would be reported were 2.45 greater for the prospective compared with the retrospective cohort (95% CI[0.55, 10.98]). The median duration of hospitalization for treatment of pancreatitis was 3 days (range 1-21 days). The pancreatitis was classified as mild in 10 cases, moderate in 3, and severe in one; one death (proximate cause, pulmonary embolism) occurred after the development of pancreatitis in a patient with multiple comorbid conditions.


CONCLUSIONS
EUS-guided FNA of solid pancreatic masses is infrequently associated with acute pancreatitis. The procedure appears to be safe when performed by experienced endosonographers. The frequency of post EUS-guided FNA pancreatitis may be underestimated by retrospective analysis.
Endoscopic Ultrasound Program, University of Alabama, 1530 3rd Avenue South, ZRB 636, Birmingham, AL 35294-0007, USA.
Mohamad A
MA
Eloubeidi
Frank G
FG
Gress
Thomas J
TJ
Savides
Maurits J
MJ
Wiersema
Michael L
ML
Kochman
Nuzhat A
NA
Ahmad
Gregory G
GG
Ginsberg
Richard A
RA
Erickson
John
J
Dewitt
Jacques
J
Van Dam
Nicholas J
NJ
Nickl
Michael J
MJ
Levy
Jonathan E
JE
Clain
Amitabh
A
Chak
Michael V
MV
Sivak
Richard
R
Wong
Gerard
G
Isenberg
James M
JM
Scheiman
Brenna
B
Bounds
Michael B
MB
Kimmey
Michael D
MD
Saunders
Kenneth J
KJ
Chang
Ashish
A
Sharma
Phoniex
P
Nguyen
John G
JG
Lee
Steven A
SA
Edmundowicz
Dayna
D
Early
Riad
R
Azar
Babak
B
Etemad
Yang K
YK
Chen
Irving
I
Waxman
Vanessa
V
Shami
Mark F
MF
Catalano
C Mel
CM
Wilcox
D000208:Acute Disease; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D019160:Endosonography / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016017:Odds Ratio; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology*; D010195:Pancreatitis / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States