title: Rarity of severe bleeding and perforation in endoscopic ultrasound-guided fine needle aspiration for submucosal tumors.
abstract: BACKGROUND
  Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an established procedure for the pathological diagnosis of gastrointestinal submucosal tumors (SMTs). Although bleeding and perforation are potentially severe complications of EUS-FNA, the incidences and severities of these complications have not yet been fully evaluated because of their relative rarity.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the incidences and mortality of severe bleeding and perforation in patients who underwent EUS-FNA for SMTs.
  
  
  METHODS
  The records of 1,135 consecutive patients who underwent EUS-FNA for SMTs at 219 hospitals, with low- to high-volume, were reviewed using a Japanese nationwide administrative database.
  
  
  RESULTS
  Of the targeted lesions 73.5% were located in the stomach, 13.4% in the esophagus, 8.2% in the duodenum, and 4.9% at other sites. Five patients (0.44%) experienced severe bleeding requiring red blood cell transfusion or endoscopic treatment, with none experiencing perforation. Only one patient (0.09%) died in-hospital within 30 days of EUS-FNA (0.09%), with death not associated with bleeding or perforation.
  
  
  CONCLUSIONS
  EUS-FNA is safe in evaluating SMTs, with low risks of bleeding and perforation.
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. hamada-tky@umin.ac.jp
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamada
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Nakai
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
authors.forename: Kiyohide
authors.initials: K
authors.lastname: Fushimi
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis*; D006801:Humans; D007413:Intestinal Mucosa / Q000098:blood supply / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies