title: Pancreatic leak after endoscopic ultrasound guided fine needle aspiration managed by transpapillary pancreatic duct stenting.
abstract: BACKGROUND
  Endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) is a front line test used for the diagnosis of solid as well as cystic lesions of the pancreas. This procedure is fairly well tolerated and associated with minimal complications. Local complications such as perforation and pancreatitis have been reported with EUS-FNA, albeit rarely. Although pancreatic duct injury can occur during EUS-FNA, symptomatic pancreatic duct leak as a complication of this procedure has never been reported.
  
  
  METHODS
  We present a 67-year-old patient who developed symptomatic ascites after EUS-FNA of a pancreatic neck lesion that required several paracenteses. Analysis of the ascitic fluid revealed that the fluid amylase and lipase levels were very high consistent with pancreatic ascites. An endoscopic retrograde pancreatography was subsequently performed that documented the presence of a pancreatic duct leak in the neck. The pancreatic duct leak and the ascites resolved after placing a pancreatic duct stent.
  
  
  CONCLUSIONS
  A clinically significant pancreatic leak can occur as a rare complication of EUS-FNA that can be effectively managed by endoscopic retrograde pancreatography and placement of a transpapillary pancreatic duct stent.
authors: Division of Gastroenterology, Department of Medicine, Creighton University Medical Center, Omaha, NE, USA.
authors: Savio
authors: S
authors: Reddymasu
authors: Melissa M
authors: MM
authors: Oropeza-Vail
authors: Stephen
authors: S
authors: Williamson
authors: Faisal
authors: F
authors: Jafri
authors: Mojtaba
authors: M
authors: Olyaee
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000601:surgery*; D044963:Biopsy, Fine-Needle / Q000009:adverse effects; D019160:Endosonography / Q000009:adverse effects; D005260:Female; D006801:Humans; D010179:Pancreas / Q000293:injuries* / Q000473:pathology*; D016035:Pancreas Transplantation / Q000379:methods*; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery; D010189:Pancreatic Juice; D015607:Stents; D018084:Ultrasonography, Interventional / Q000009:adverse effects*