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Biliopancreatic Endoscopy pp 235–248Cite as

Endoscopic Ultrasonography (EUS) Related Complications and Management

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Abstract

EUS was regarded as the best staging modality of GI tract and EUS-guided fine needle aspiration (EUS-FNA) was a safe procedure for obtaining cytopathological specimens from tumor adjacent to GI tract and lymph nodes. The complication rate was 0.03–0.15% for diagnostic EUS which was comparable to that of upper gastrointestinal tract diagnostic endoscopy, while the complication rate of EUS-FNA is 0.3–6.3%, comparable to colonoscopy with polypectomy. The insertion or advancement of echoendoscopes either radial or linear type carried the risk of esophageal or duodenal perforation due to their specific mechanical (diameter and nonflexible tip) and optic properties (oblique-viewing). The prolonged procedure is also prone to sedative complications on cardiopulmonary system. The common complications of EUS-FNA depend on the target lesions and methods of intervention, such as iatrogenic pancreatitis, bleeding, and infection. Rare complications include bile peritonitis, pneumoperitoneum, and malignant seeding along needle tract. IDUS carries the low complication rate of 0–1.5%, comparable to that of ERCP, including pancreatitis and cholangitis. To prevent or minimize the complications of EUS/EUS-FNA, one should receive adequate supervised EUS training, follow the updated practice guideline, identify high-risk lesions (stenotic cancer, pancreatitis and pancreatic cystic lesions) for adjuvant prophylaxis, and patient’s underlying factors (anti-thrombotic use and adverse sedation history). With the advances of EUS technique for new interventional indications avoiding radiation risk, EUS will gain popularity and advantage over CT scan, fluoroscopy, and laparotomy in the pancreaticobiliary disorders in near future.

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References

  1. DiMagno EP, Buxton JL, Regan PT, et al. Ultrasonic endoscope. Lancet. 1980;1:629–31.

    Article  CAS  PubMed  Google Scholar 

  2. DiMagno EP, DiMagno MJ. Endoscopic ultrasonography: from the origins to routine EUS. Dig Dis Sci. 2016;61:342–53.

    Article  PubMed  Google Scholar 

  3. Vilmann P, Jacobsen GK, Henriksen FW, et al. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc. 1992;38:172–3.

    Article  CAS  PubMed  Google Scholar 

  4. Jenssen C, Alvarez-Sánchez MV, Napoléon B, et al. Diagnostic endoscopic ultrasonography: assessment of safety and prevention of complications. World J Gastroenterol. 2012;18(34):4659–76.

    Article  PubMed  PubMed Central  Google Scholar 

  5. ASGE Technology Committee, Murad FM, Komanduri S, Dayyeh BK, et al. Echoendoscopes. Gastrointest Endosc. 2015;82:189–202.

    Article  Google Scholar 

  6. Kaldjian LC, Jones EW, Wu BJ, et al. Reporting medical errors to improve patient safety: a survey of physicians in teaching hospitals. Arch Intern Med. 2008;168(1):40–6.

    Article  PubMed  Google Scholar 

  7. ASGE Technology Committee, Kaul V, Adler DG, Conway JD, et al. Interventional EUS. Gastrointest Endosc. 2010;72:1–4.

    Article  Google Scholar 

  8. ASGE Standards of Practice Committee, Early DS, Acosta RD, Chandrasekhara V. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc. 2013;77:839–43.

    Article  Google Scholar 

  9. Jenssen C, Mayr M, Nuernberg D. Complications of endoscopic ultrasound: risk assessment and prevention. In: Dietrich CF, editor. Endoscopic ultrasound: an introductory manual and atlas. Stuttgart: Thieme; 2011. p. 176–96.

    Google Scholar 

  10. Lachter J. Fatal complications of endoscopic ultrasonography: a look at 18 cases. Endoscopy. 2007;39:747–50.

    Article  CAS  PubMed  Google Scholar 

  11. Mahajan R, Simon EG, Chacko A, et al. Endoscopic ultrasonography in pediatric patients—experience from a tertiary care center in India. Indian J Gastroenterol. 2016;35:14–9.

    Article  PubMed  Google Scholar 

  12. Attila T, Faigel DO. Endoscopic ultrasound in patients over 80 years old. Dig Dis Sci. 2011;56:3065–71.

    Article  PubMed  Google Scholar 

  13. Benson ME, Byrne S, Brust DJ, et al. EUS and ERCP complication rates are not increased in elderly patients. Dig Dis Sci. 2010;55:3278–83.

    Article  PubMed  Google Scholar 

  14. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists, Gross JB, Bailey PL, Caplan RA, et al. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96:1005.

    Article  Google Scholar 

  15. Silvis SE, Nebel O, Rogers G, et al. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy survey. JAMA. 1976;235:928–30.

    Article  CAS  PubMed  Google Scholar 

  16. Lichtenstein DR, Jagannath S, Baron TH, et al. Sedation and anesthesia in GI endoscopy. Gastrointest Endosc. 2008;68:815–26.

    Article  PubMed  Google Scholar 

  17. Gross JB, Bailey PL, Connis RT, et al. Practice guidelines for sedation and analgesia by nonanesthesiologists. Anesthesiology. 2002;96:1004–17.

    Article  Google Scholar 

  18. Patel S, Vargo JJ, Khandwala F, et al. Deep sedation occurs frequently during elective endoscopy with meperidine and midazolam. Am J Gastroenerol. 2005;100:2689–95.

    Article  CAS  Google Scholar 

  19. Dewitt J, McGreevy K, Sherman S, et al. Nurse administered propofol sedation compared with midazolam and meperidine for EUS: a prospective, randomized trial. Gastrointest Endosc. 2008;68:499–509.

    Article  PubMed  Google Scholar 

  20. Nayar DS, GuthrieWG GA, et al. Comparison of propofol deep sedation versus moderate sedation during endosonography. Dig Dis Sci. 2010;55(9):2537–44.

    Article  CAS  PubMed  Google Scholar 

  21. Campbell JA, Irvine AJ, Hopper AD. Endoscopic ultrasound sedation in the United Kingdom: is life without propofol tolerable? World J Gastroenterol. 2017;23(3):560–2.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Rösch T, Dittler HJ, Fockens P, et al. Major complications of endoscopic ultrasonography: results of a survey of 42105 cases [abstract]. Gastrointest Endosc. 1993;39:370.

    Google Scholar 

  23. Das A, Sivak MV, Chak A. Cervical esophageal perforation during EUS: a national survey. Gastrointest Endosc. 2001;53:599–602.

    Article  CAS  PubMed  Google Scholar 

  24. Eloubeidi MA, Tamhane A, Lopes TL, et al. Cervical esophageal perforations at the time of endoscopic ultrasound: a prospective evaluation of frequency, outcomes, and patient management. Am J Gastroenterol. 2009;104:53–6.

    Article  PubMed  Google Scholar 

  25. Mortensen MB, Fristrup C, Holm FS, et al. Prospective evaluation of patient tolerability, satisfaction with patient information, and complications in endoscopic ultrasonography. Endoscopy. 2005;37:146–53.

    Article  CAS  PubMed  Google Scholar 

  26. Wang KX, Ben QW, Jin ZD, et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc. 2011;73:283–90.

    Article  PubMed  Google Scholar 

  27. Van Dam J, Rice TW, Catalano MF, et al. High-grade malignant stricture is predictive of esophageal tumor stage: risks of endosonographic evaluation. Cancer. 1993;71:2910–7.

    Article  PubMed  Google Scholar 

  28. Wallace MB, Hawes RH, Sahai AV, et al. Dilation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management. Gastrointest Endosc. 2000;51:309–13.

    Article  CAS  PubMed  Google Scholar 

  29. Mallery S, Vandam J. Increased rate of complete EUS staging of patients with esophageal cancer using the nonoptical, wire-guided echoendoscope. Gastrointest Endosc. 1999;50:53–7.

    Article  CAS  PubMed  Google Scholar 

  30. Raut CP, Grau AM, Staerkel GA, et al. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration in patients with presumed pancreatic cancer. J Gastrointest Surg. 2003;7:118–26.

    Article  PubMed  Google Scholar 

  31. Jenssen C, Faiss S, Nürnberg D. Complications of endoscopic ultrasound and endoscopic ultrasound-guided interventions—results of a survey among German centers. Z Gastroenterol. 2008;46:1177–84.

    Article  CAS  PubMed  Google Scholar 

  32. Gottschalk U, Dffelmeyer M, Jenssen C. Komplikationserfassung der diagnostischen und therapeutischen Endosonografie. Z Gastroenterol. 2011;49:V118.

    Article  Google Scholar 

  33. O’Toole D, Palazzo L, Arotcarena R, et al. Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc. 2001;53:470–4.

    Article  PubMed  Google Scholar 

  34. Gress F, Michael H, Gelrud D, et al. EUS-guided fine-needle aspiration of the pancreas: evaluation of pancreatitis as a complication. Gastrointest Endosc. 2002;56:864–7.

    Article  PubMed  Google Scholar 

  35. Eloubeidi MA, Gress FG, Savides TJ. Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States. Gastrointest Endosc. 2004;60:385–9.

    Article  PubMed  Google Scholar 

  36. Reddymasu S, Oropeza-Vail MM, Williamson S, et al. Pancreatic leak after endoscopic ultrasound guided fine needle aspiration managed by transpapillary pancreatic duct stenting. JOP. 2011;12:489–90.

    PubMed  Google Scholar 

  37. Babich JP, Bonasera RJ, Klein J, Friedel DM. Pancreatic ascites: complication after endoscopic ultrasound-guided fine needle aspiration of a pancreatic cyst. Endoscopy. 2009;41(Suppl 2):E211–2.

    Article  PubMed  Google Scholar 

  38. Lee LS, Saltzman JR, Bounds BC, et al. EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors. Clin Gastroenterol Hepatol. 2005;3:231–6.

    Article  PubMed  Google Scholar 

  39. Hollerbach S, Klamann A, Topalidis T, et al. Endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA) cytology for diagnosis of chronic pancreatitis. Endoscopy. 2001;33:824–31.

    Article  CAS  PubMed  Google Scholar 

  40. DeWitt J, McGreevy K, LeBlanc J, et al. EUS-guided Trucut biopsy of suspected nonfocal chronic pancreatitis. Gastrointest Endosc. 2005;62:76–84.

    Article  PubMed  Google Scholar 

  41. Gress FG, Hawes RH, Savides TJ, et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy using linear array and radial scanning endosonography. Gastrointest Endosc. 1997;45:243–50.

    Article  CAS  PubMed  Google Scholar 

  42. Voss M, Hammel P, Molas G, et al. Value of endoscopic ultrasound guided fine needle aspiration biopsy in the diagnosis of solid pancreatic masses. Gut. 2000;46:244–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Affi A, Vazquez-Sequeiros E, Norton ID, et al. Acute extraluminal hemorrhage associated with EUS-guided fine needle aspiration: frequency and clinical significance. Gastrointest Endosc. 2001;53:221–5.

    Article  CAS  PubMed  Google Scholar 

  44. Kien-Fong Vu C, Chang F, Doig L, et al. A prospective control study of the safety and cellular yield of EUS-guided FNA or Trucut biopsy in patients taking aspirin, nonsteroidal anti-inflammatory drugs, or prophylactic low molecular weight heparin. Gastrointest Endosc. 2006;63:808–13.

    Article  PubMed  Google Scholar 

  45. Sahai AV. Balloon-assisted esophageal intubation to prevent cervical perforation during EUS. Gastrointest Endosc. 2002;55:140–1.

    Article  PubMed  Google Scholar 

  46. Trindade AJ, Hirten R, Slattery E, et al. Endoscopic ultrasound-guided fine-needle aspiration of solid lesions on clopidogrel may not be a high-risk procedure for bleeding: a case series. Dig Endosc. 2016;28(2):216–9.

    Article  PubMed  Google Scholar 

  47. Buscarini E, De Angelis C, Arcidiacono PG, et al. Multicentre retrospective study on endoscopic ultrasound complications. Dig Liver Dis. 2006;38:762–7.

    Article  CAS  PubMed  Google Scholar 

  48. Varadarajulu S, Eloubeidi MA. Frequency and significance of acute intracystic hemorrhage during EUS-FNA of cystic lesions of the pancreas. Gastrointest Endosc. 2004;60:631–5.

    Article  PubMed  Google Scholar 

  49. Andrews AH, Horwhat JD. Massive pneumoperitoneum after EUS-FNA aspiration of the pancreas. Gastrointest Endosc. 2006;63:876–7.

    Article  PubMed  Google Scholar 

  50. Larino-Noia J, Iglesias-Garcia J, Seijo-Rios S, et al. Assessment of EUS and EUS-guided FNA complications in a large cohort of patients [abstract]. Endoscopy. 2006;39(Suppl 1):39–FR46.

    Google Scholar 

  51. Vazquez-Sequeiros E, Levy MJ, Van Domselaar M, et al. Diagnostic yield and safety of endoscopic ultrasound guided fine needle aspiration of central mediastinal lung masses. Diagn Ther Endosc. 2013. https://doi.org/10.1155/2013/150492.

  52. Chang KJ, Nguyen P, Erickson RA, et al. The clinical utility of endoscopic ultrasound-guided fine needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc. 1997;45:387–93.

    Article  CAS  PubMed  Google Scholar 

  53. Barawi M, Gottlieb K, Cunha B, et al. A prospective evaluation of the incidence of bacteremia associated with EUS-guided fine-needle aspiration. Gastrointest Endosc. 2001;53:189–92.

    Article  CAS  PubMed  Google Scholar 

  54. Levy MJ, Norton ID, Wiersema MJ, et al. Prospective risk assessment of bacteremia and other infectious complications in patients undergoing EUS-guided FNA. Gastrointest Endosc. 2003;57:672–8.

    Article  PubMed  Google Scholar 

  55. Wiersema MJ, Vilmann P, Giovannini M, et al. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997;112:1087–95.

    Article  CAS  PubMed  Google Scholar 

  56. Guarner-Argente C, Shah P, Buchner A, et al. Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis. Gastrointest Endosc. 2011;74:81–6.

    Article  PubMed  Google Scholar 

  57. Sing J, Erickson R, Fader R. An in vitro analysis of microbial transmission during EUS-guided FNA and the utility of sterilization agents. Gastrointest Endosc. 2006;64:774–9.

    Article  PubMed  Google Scholar 

  58. Chen HY, Lee CH, Hsieh CH. Bile peritonitis after EUS-guided fine-needle aspiration. Gastrointest Endosc. 2002;56:594–6.

    Article  PubMed  Google Scholar 

  59. Jacobson BC, Waxman I, Parmar K, et al. Endoscopic ultrasound-guided gallbladder bile aspiration in idiopathic pancreatitis carries a significant risk of bile peritonitis. Pancreatology. 2002;2:26–9.

    Article  PubMed  Google Scholar 

  60. Wu LM, Jiang XX, Gu HY, et al. Endoscopic ultrasound-guided fine-needle aspiration biopsy in the evaluation of bile duct strictures and gallbladder masses: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2011;23:113–20.

    Article  PubMed  Google Scholar 

  61. Paquin SC, Gariépy G, Lepanto L, et al. A first report of tumor seeding because of EUS guided FNA of a pancreatic adenocarcinoma. Gastrointest Endosc. 2005;61:610–1.

    Article  PubMed  Google Scholar 

  62. Chong A, Venugopal K, Segarajasingam D, et al. Tumor seeding after EUS-guided FNA of pancreatic tail neoplasia. Gastrointest Endosc. 2011;74:933–5.

    Article  PubMed  Google Scholar 

  63. Ahmed K, Sussman JJ, Wang J, et al. A case of EUS-guided FNA-related pancreatic cancer metastasis to the stomach. Gastrointest Endosc. 2011;74:231–3.

    Article  PubMed  Google Scholar 

  64. Shah JN, Fraker D, Guerry D, et al. Melanoma seeding of an EUS-guided fine needle track. Gastrointest Endosc. 2004;59:923–4.

    Article  PubMed  Google Scholar 

  65. Hirooka Y, Goto H, Itoh A, et al. Case of intraductal papillary mucinous tumor in which endosonography-guided fine-needle aspiration biopsy caused dissemination. J Gastroenterol Hepatol. 2003;18:1323–4.

    Article  PubMed  Google Scholar 

  66. Yamabe A, Irisawa A, Shibukawa G, et al. Rare condition of needle tract seeding after EUS-guided FNA for intraductal papillary mucinous carcinoma. Endosc Int Open. 2016;4(7):E756–8. https://doi.org/10.1055/s-0042-107072.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Levy MJ, Gleeson FC, Campion MB, et al. A prospective cytological assessment of gastrointestinal luminal fluid acquired during EUS: a potential source of false-positive FNA and needle tract seeding. Am J Gastroenterol. 2010;105:1311–8.

    Article  PubMed  Google Scholar 

  68. Ngamruengphong S, Swanson KM, Shah ND, et al. Preoperative endoscopic ultrasound-guided fine needle aspiration does not impair survival of patients with resected pancreatic cancer. Gut. 2015;64:1105–10.

    Article  PubMed  Google Scholar 

  69. Vazquez-Sequeiros E, Baron T, Clain J, et al. Evaluation of indeterminate bile duct strictures by intraductal US. Gastrointest Endosc. 2002;56:372–9.

    Article  PubMed  Google Scholar 

  70. Menzel J, Domschke W. Intraductal ultrasonography (IDUS) of the pancreato-biliary duct system, personal experience and review of literature. Eur J Ultrasound. 1999;10:105–15.

    Article  CAS  PubMed  Google Scholar 

  71. Furukawa T, Oohashi K, Yamao K, et al. Intraductal ultrasonography of the pancreas: development and clinical potential. Endoscopy. 1997;29:561–9.

    Article  CAS  PubMed  Google Scholar 

  72. Meister T, Heinzow H, Heinecke A, et al. Post-ERCP pancreatitis in 2364 ERCP procedures: is intraductal ultrasonography another risk factor? Endoscopy. 2011;43:331–3.

    Article  CAS  PubMed  Google Scholar 

  73. Park SY, Park CH, Lim SU, et al. Intraductal US-directed management of bile duct stones without radiocontrast cholangiography. Gastrointest Endosc. 2015;82:939–43.

    Article  PubMed  Google Scholar 

  74. Lim SU, Park CH, Kee WJ, et al. Intraductal ultrasonography without radiocontrast cholangiogramin patients with extrahepatic biliary disease. Gut Liver. 2015;9:540–6.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Rew SJ, Lee DH, Park CH, et al. Comparison of intraductal ultrasonography-directed and cholangiography-directed endoscopic retrograde biliary drainage in patients with a biliary obstruction. Korean J Intern Med. 2016;31:872–9.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Polkowski M, Larghi A, Weynand B, et al. Learning, techniques, and complications of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline. Endoscopy. 2012;44:190–206.

    Article  CAS  PubMed  Google Scholar 

  77. Shah JN, Muthusamy VR. Minimizing complications of endoscopic ultrasound and EUS-guided fine needle aspiration. Gastrointest Endosc Clin N Am. 2007;17:129–43.

    Article  PubMed  Google Scholar 

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  1. Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan

    Chun-Jung Lin

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  1. Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Kwok-Hung Lai

  2. Show-Chwan Health Care System, Chang-Hua, Taiwan

    Lein-Ray Mo

  3. Division of Gastroenterology, Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan

    Hsiu-Po Wang

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Lin, CJ. (2018). Endoscopic Ultrasonography (EUS) Related Complications and Management. In: Lai, KH., Mo, LR., Wang, HP. (eds) Biliopancreatic Endoscopy. Springer, Singapore. https://doi.org/10.1007/978-981-10-4367-3_21

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