title: Incidence of bleeding in 8172 percutaneous ultrasound-guided intraabdominal diagnostic and therapeutic interventions - results of the prospective multicenter DEGUM interventional ultrasound study (PIUS study).
abstract: OBJECTIVE
  To analyse the incidence of bleeding after percutaneous ultrasound guided diagnostic and therapeutic intraabdominal interventions in a prospective multicentre study (DEGUM percutaneous interventional ultrasound study).
  
  
  METHODS
  Within a time period of 2 years diagnostic and therapeutic intraabdominal interventions (with the exclusion of ascites paracentesis) performed percutaneously under continuous ultrasound (US) guidance were prospectively assessed using a pseudonymized standardized web site entry form. Number and type of intervention, operator experience, patient characteristics, medication, lab data as well as technical aspects of the procedure and bleeding complications were analysed according to the interventional radiology standards.
  
  
  RESULTS
  8172 US-guided intraabdominal interventions (liver n = 5903; pancreas n = 501, kidney n = 434, lymph node = 272, biliary system n = 153, spleen n = 63, other abdominal organs and extra-organic targets n = 999) were analysed in 30 hospitals. The majority were diagnostic biopsies including 1780 liver parenchyma, 3400 focal liver lesions and 404 pancreatic lesions. 7525 interventions (92.1 %) were performed in hospitalized patients (mean age 62.6 years). Most operators were highly experienced in US-guided interventions (> 500 interventions prior to the study n = 5729; 70.1 %). Sedation was administered in 1131 patients (13.8 %). Needle diameter was ≥ 1 mm in 7162 punctures (87.9 %) with main focus on core needle biopsies (18 G, n = 4185). Clinically relevant bleeding complications with need of transfusion (0.4 %), surgical bleeding control (0.1 %) and radiological coiling (0.05 %) were very rare. Bleeding complications with fatal outcome occurred in four patients (0.05 %). The frequency of major bleeding complications was significantly higher in patients with an INR > 1.5 (p < 0.001) and patients taking a medication potentially interfering with platelet function or plasmatic coagulation (p < 0.0333).
  
  
  CONCLUSIONS
  This prospective multicentre study confirms the broad spectrum of percutaneous US-guided intraabdominal interventions. However diagnostic liver biopsies dominate with the use of core needle biopsies (18 G). Percutaneous US-guided interventions performed by experienced sonographers are associated with a low bleeding risk. Major bleeding complications are very rare. A pre-interventional INR < 1.5 and individual medication risk assessment are recommended.
authors: Internal Medicine 1, University Hospital Erlangen, Germany.
authors: D
authors: D
authors: Strobel
authors: Department of Internal Medicine, District Hospital Ebersberg, Germany.
authors: T
authors: T
authors: Bernatik
authors: Department of Internal Medicine 1, Municipal Hospital Steinenberg, Reutlingen, Germany.
authors: W
authors: W
authors: Blank
authors: Department of Gastroenterology, Municipal Hospital (Waldklinikum Gera gGmbH), Gera, Germany.
authors: U
authors: U
authors: Will
authors: Department of Gastroenterology, Municipal Hospital (Waldklinikum Gera gGmbH), Gera, Germany.
authors: A
authors: A
authors: Reichel
authors: Central Interdisciplinary Ultrasound, Municipal Hospital Trier (Barmherzige Brüder), Trier, Germany.
authors: M
authors: M
authors: Wüstner
authors: Department of Gastroenterology, Central Ultrasound Unit, University Hospital Leipzig, Germany.
authors: V
authors: V
authors: Keim
authors: Department of Internal Medicine 1, University Hospital Regensburg, Germany.
authors: D
authors: D
authors: Schacherer
authors: Department of Internal Medicine 1, University Hospital Mainz, Germany.
authors: A P
authors: AP
authors: Barreiros
authors: Department of Internal Medicine 1, Municipal Hospital (Schwarzwald-Baar), Villingen-Schwenningen, Germany.
authors: G
authors: G
authors: Kunze
authors: Department of Internal Medicine B, Gastroenterology, District Hospital (Ruppiner Kliniken), Neuruppin, Germany.
authors: D
authors: D
authors: Nürnberg
authors: Department of Internal Medicine 2, Municipal Hospital (Caritas), Bad Mergentheim, Germany.
authors: A
authors: A
authors: Ignee
authors: Department of Internal Medicine/Gastroenterology, Municipal Hospital (Sana Kliniken Lübeck GmbH), Lübeck, Germany.
authors: E
authors: E
authors: Burmester
authors: Surgery, University Hospital Dresden, Germany.
authors: A A
authors: AA
authors: Bunk
authors: Department of Internal Medicine 1, University Hospital Frankfurt, Germany.
authors: M
authors: M
authors: Friedrich-Rust
authors: Department of Internal Medicine 1, Municipal Hospital (Karl-Olga-Krankenhaus), Stuttgart, Germany.
authors: E
authors: E
authors: Froehlich
authors: Department of Internal Medicine, District Hospital Helfenstein, Geislingen, Germany.
authors: A
authors: A
authors: Schuler
authors: Department of Internal Medicine, District Hospital (Krankenhaus Märkisch Oderland GmbH), Wriezen, Germany.
authors: C
authors: C
authors: Jenssen
authors: Department of Medicine and Gastroenterology, Municipal Hospital (Katharinen), Stuttgart, Germany.
authors: W
authors: W
authors: Bohle
authors: Innere Medicine, District Hospital (SRH Kliniken Sigmaringen), Sigmaringen, Germany.
authors: M
authors: M
authors: Mauch
authors: Department of Interal Medicine and Gastroenterology, District Hospital Rems-Murr, Winnenden, Germany.
authors: K
authors: K
authors: Dirks
authors: Depatment of Internal Medicine, Hospital St Hedwig, Berlin, Germany.
authors: J
authors: J
authors: Kaemmer
authors: Department of Internal Medicine, Israeli Hospital, Hamburg, Germany.
authors: C
authors: C
authors: Pachmann
authors: Gastroenterology, Hospital Vivantes Humboldt, Berlin, Germany.
authors: J
authors: J
authors: Stock
authors: Department of Medicine 2 and Gastroenterology, District Hospital Helios Meiningen, Germany.
authors: M
authors: M
authors: Hocke
authors: Department of Internal Medicine, District Hospital Gummersbach, Germany.
authors: A
authors: A
authors: Kendel
authors: Department of Internal Medicine, Hospital Albertinen, Hamburg, Germany.
authors: C
authors: C
authors: Schmidt
authors: Gastroenterology, St. Josefs Hospital (Helios), Bochum, Germany.
authors: C
authors: C
authors: Jakobeit
authors: Department of Internal Medicine 2, Municipal Hosital Düren, Germany.
authors: H
authors: H
authors: Kinkel
authors: Department of Internal Medicine, Hospital Leonberg, Germany.
authors: W
authors: W
authors: Heinz
authors: Department of Internal Medicine, District Hospital Köthen, Germany.
authors: G
authors: G
authors: Hübner
authors: Campus Innenstadt Gastroenterology, University Hospital Munich, Germany.
authors: M
authors: M
authors: Pichler
authors: Department of Internal Medicine 1, Municipal Hospital Steinenberg, Reutlingen, Germany.
authors: T
authors: T
authors: Müller
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062005:Biopsy, Large-Core Needle / Q000009:adverse effects*; D002648:Child; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005260:Female; D006465:Hemoperitoneum / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D018084:Ultrasonography, Interventional / Q000009:adverse effects* / Q000706:statistics & numerical data; D014781:Viscera / Q000473:pathology*; D055815:Young Adult