title: Assessment of morbidity and mortality associated with endoscopic ultrasound-guided fine-needle aspiration for pancreatic cystic lesions: A systematic review and meta-analysis.
abstract: OBJECTIVE
  With increased availability of imaging technology, detection of pancreatic cystic lesions (PCL) is on the rise. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) improves the diagnosis accuracy of PCL. Systematic evaluation of morbidity and mortality associated with EUS-FNA for PCL has not been carried out. We conducted a systematic review and meta-analysis of morbidity and mortality associated with EUS-FNA.
  
  
  METHODS
  A literature search for relevant English-language articles was conducted on PubMed and EMBASE databases. Main outcome measures for this analysis were adverse effects of diagnostic EUS-FNA, and the associated morbidity and mortality, in patients with PCL.
  
  
  RESULTS
  Forty studies, with a combined subject population of 5124 patients with PCL, satisfied the inclusion criteria. Overall morbidity as a result of adverse events of EUS-FNA was 2.66% (95% confidence interval [CI]: 1.84-3.62%), and the associated mortality was 0.19% (95% CI: 0.09-0.32%). Common post-procedure adverse events included pancreatitis 0.92% (95% CI: 0.63-1.28%), hemorrhage 0.69% (95% CI: 0.42-1.02%), pain 0.49% (95% CI: 0.27-0.79%), infection 0.44% (95% CI: 0.27-0.66%), desaturation 0.23% (95% CI: 0.12-0.38%) and perforation 0.21% (95% CI: 0.11-0.36%). There was no peritoneal seeding in our study. Incidence of adverse events associated with prophylactic periprocedural antibiotic use was 2.77% (95% CI: 1.87-3.85%).
  
  
  CONCLUSIONS
  EUS-FNA is a safe procedure for diagnosis of PCL and is associated with a relatively low incidence of adverse events. Most adverse events were mild, self-limiting, and did not require medical intervention.
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Huiyun
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Jiang
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yiqi
authors.initials: Y
authors.lastname: Du
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhendong
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Zhaoshen
authors.initials: Z
authors.lastname: Li
mesh_terms: D001707:Biopsy, Needle; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods* / Q000401:mortality*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009017:Morbidity; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000401:mortality; D061214:Patient Safety; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate
keywords: adverse event; cyst; endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA); meta-analysis; pancreas