Background and Aims
Pancreatic cysts and solid lesions are routinely examined by EUS-guided FNA (EUS-FNA).
The aim of this study was to compare the incidence of adverse events (AEs) of this
procedure by using the lexicon recommended by the American Society for Gastrointestinal
Endoscopy (ASGE).
Methods
This was a prospective and comparative study of patients who underwent EUS-FNA in
which a 22-gauge needle was used. In the pancreatic cystic lesions group (group I),
complete fluid evacuation in a single needle pass was attempted, and ciprofloxacin
was given during the procedure and for 3 days after. In the pancreatic solid lesions
group (group II), the number of passes was determined by the on-site evaluation of
the sample. AEs were defined and graded according to the lexicon recommended by the
ASGE. Patients were followed for 48 hours, 1 week, and 1 month after the procedure.
Results
A total of 146 patients were included, 73 in group I and 73 in group II. Potential
factors influencing the incidence of AEs (ie, access route for FNA) were similar in
both groups. AEs occurred in 5 of 146 patients (3.4%; 95% confidence interval [CI],
1.3%-8%): 4 in group I (5.5%; 95% CI, 1.7%-13.7%) and 1 in group II (1.4%; 95% CI, −0.5%
to 8.1%) (P = .03). Severity was mild in 1 of 5 patients (20%) and moderate in 3 of 5 patients
(60%). One patient with a solid mass in the head of the pancreas had a duodenal perforation
after EUS and died after surgery. All other AEs occurred in the first 48 hours and
resolved with medical therapy. There were 3 incidents of transient hypoxia and self-limited
abdominal pain in 1 and 2 patients, respectively. No patients were lost to follow-up.
Conclusion
EUS-FNA of pancreatic cysts has an AEs rate similar to that of solid pancreatic masses,
which is small enough to consider this procedure a safe and effective method for managing
patients with both types of lesions. AEs occurred early after EUS-FNA, and patients
should be closely followed during the first 2 days after the procedure.
Abbreviations:
AE (adverse event), ASGE (American Society for Gastrointestinal Endoscopy), CI (confidence interval), CTCAE (Common Technology Criteria for Adverse Events), EUS-FNA (EUS-guided FNA), PCL (pancreatic cystic lesion), PSL (pancreatic solid lesion), IPMN (Intraductal papillary mucinous neoplasm)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diagnostic and radiological management of cystic pancreatic lesions: important features for radiologists.Clin Radiol. 2012; 67: 727-737
- Prevalence of unsuspected pancreatic cysts on MDCT.AJR Am J Roentgenol. 2008; 191: 802-807
- Prevalence of incidental pancreatic cysts in the adult population on MR imaging.Am J Gastroenterol. 2010; 105: 2079-2084
- Pancreatic cystic lesions: How endoscopic ultrasound morphology and endoscopic ultrasound fine needle aspiration help unlock the diagnostic puzzle.World J Gastrointest Endosc. 2012; 4: 247
- American Gastroenterological Association institute guideline on the diagnosis and management of neoplastic pancreatic cysts.Gastroenterology. 2015; 148: 819-822
- International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas.Pancreatology. 2012; 12: 183-197
- Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: final results from a large prospective multicenter study.Dig Liver Dis. 2014; 46: 41-44
- Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment.Gastroenterology. 1997; 112: 1087-1095
- Assessment of complications of EUS-guided fine-needle aspiration.Gastrointest Endosc. 2001; 53: 470-474
- Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review.Gastrointest Endosc. 2011; 73: 283-290
- A lexicon for endoscopic adverse events: report of an ASGE workshop.Gastrointest Endosc. 2010; 71: 446-454
- Clinical usefulness of KRAS mutational analysis in the diagnosis of pancreatic adenocarcinoma by means of endosonography-guided fine-needle aspiration biopsy.Aliment Pharmacol Ther. 2003; 17: 1299-1307
National Cancer Institute. Adverse Events/CTCAE. Available at: http://ctep.cancer.gov/protocolDevelopment/adverse_effects.htm. Accessed March 17, 2015.
- Adverse events associated with EUS and EUS with FNA.Gastrointest Endosc. 2013; 77: 839-843
- Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: Final results from a large prospective multicenter study.Dig Liver Dis. 2013; : 8-11
- EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors.Clin Gastroenterol Hepatol. 2005; 3: 231-236
- The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study.Endoscopy. 2008; 40: 204-208
- Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis.Gastrointest Endosc. 2011; 74: 81-86
- Outcomes of endoscopy procedures: struggling towards definitions.Gastrointest Endosc. 1994; 40: 514-518
Article info
Publication history
Published online: August 21, 2015
Accepted:
August 7,
2015
Received:
March 20,
2015
Footnotes
DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Ginès at [email protected]
Identification
Copyright
© 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
