Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation.
BACKGROUND
EUS-guided FNA is effective for establishing tissue diagnosis in suspected pancreatic cancer. However, data on the frequency of major complications following EUS-FNA are limited.


OBJECTIVE
To evaluate the frequency of major complications after EUS-FNA of solid pancreatic masses.


METHODS
Prospective cohort study.


METHODS
Tertiary University based referral center for pancreatico-biliary disorder.


METHODS
Consecutive patients who underwent EUS-FNA of a solid pancreatic over a 42-month period. All immediate complications were recorded by the endosonographer. Late complications were assessed at 72 hours and at 30-days after the procedure.


METHODS
Major complications were defined as acute pancreatitis, bleeding, infection, perforation, use of reversal medication, hospitalization or death.


RESULTS
A total of 355 consecutive patients with a solid pancreatic mass underwent EUS FNA. Major complications were encountered in 9 patients (2.54%, 95% CI 1.17-4.76). Acute pancreatitis occurred in 3 of 355 (0.85 %, 95% CI 0.17-2.45); 2 patients were hospitalized, and 1 patient recovered with outpatient analgesics. Three patients were admitted for severe pain after the procedure; all were treated with analgesics and subsequently discharged with no sequela. Two patients (0.56%, 95% CI 0.07-2.02) developed fever and were admitted for intravenous antibiotics; 1 patient recovered with intravenous antibiotics and the other required surgical debridement for necrosis. One patient required the use of reversal medication. Overall, 1.97% (95% CI 0.80-4.02) of the patients were hospitalized for complications (range 1-16 days). None of the patients experienced clinically significant hemorrhage, perforation, or death. No clear predisposing risk factors were identified.


CONCLUSIONS
Lack of surgical gold standard and referral to a tertiary center.


CONCLUSIONS
EUS-FNA of solid pancreatic masses infrequently leads to major complications. Our results can be used by endosonographers to counsel patients before EUS-FNA of solid pancreatic masses.
Department of Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294, USA. eloubeidi@uab.edu
Mohamad A
MA
Eloubeidi
Ashutosh
A
Tamhane
Shyam
S
Varadarajulu
C Mel
CM
Wilcox
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000009:adverse effects; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D019283:Pancreatitis, Acute Necrotizing / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D012421:Rupture / Q000453:epidemiology / Q000209:etiology; D015996:Survival Rate / Q000639:trends