Original Article
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

https://doi.org/10.1016/j.gie.2005.09.033Get rights and content

Background

Although the ASGE recommends that high-risk endoscopic procedures can safely be performed on patients taking aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) in standard doses, there is a paucity of data on EUS-FNA per se in this setting.

Objective

We studied the safety and cellular yield of EUS-FNA and/or Trucut biopsy (TCB) in patients taking aspirin, NSAIDS, or prophylactic low molecular weight heparins (LMWH).

Design

Prospective control study.

Patients

Consecutive patients undergoing EUS-FNA and/or TCB were recruited over an 18-month period. The usage of aspirin, NSAIDS, or LMWH were recorded and patients who were not taking these medications served as controls.

Main Outcome Measurements

The bleeding events (endosonographic findings of extraluminal bleeding, intraluminal bleeding requiring hemostatic procedures, hematemesis, or melena) and cellular yield were compared between patients and controls.

Results

Two hundred fourteen patients (8 had repeat procedures) underwent EUS-FNA and/or TCB on 241 lesions. Bleeding events occurred in none (0 of 26), 33.3% (2 of 6), and 3.7% (7 of 190) of the patients in the aspirin/NSAIDS, LMWH, and control groups, respectively (p = 0.023). The mean numbers of FNA passes, applications of suction, bloody specimens, and cellular yield were not significantly different between patients who were or were not receiving medications. No significant difference in bleeding events was noted between the FNA and TCB groups.

Conclusion

EUS-FNA or TCB is safe in patients taking aspirin or NSAIDS. Consideration should be given to stopping LMWH before the procedure. The cellular yield and blood contamination of the specimen from FNA are similar to those in controls.

Section snippets

Patients and methods

Consecutive patients undergoing EUS-FNA and/or TCB were studied prospectively for bleeding and other complications over an 18-month period. Patients' medications, in particular, aspirin, NSAIDs, and heparin/LMWH were recorded. Those receiving prophylactic doses of unfractionated heparin or LMWH were included in the study. EUS-FNA or TCB was contraindicated in patients taking warfarin or heparin/LMWH in therapeutic doses and they were managed in accordance with the ASGE guideline. Because of

Results

Two hundred fourteen consecutive patients underwent EUS-FNA or TCB over an 18-month period. Eight patients had a repeat procedure. TCB was performed on 31 patients, of whom 8 had procedures combined with FNA. The locations of the lesions were as follows: pancreas 151, intra-abdomen 55, mediastinum 34, and rectum 1. Eighteen patients had FNA performed on two separate lesions. There were 194 solid, 44 cystic or semi-cystic, and 3 ascitic cases.

The mean [SD] of the number of FNA passes was 2.2

Discussion

Studies have shown EUS-FNA or TCB to be a safe procedure with the rare occurrence of bleeding,2 pancreatitis,15, 16 or infection,17 as is also evident in this study. Our study also showed that EUS-FNA and/or TCB is/are safe in patients taking aspirin or NSAIDs, with respect to bleeding complications. This evidence concurs with and enhances the validity of the ASGE guideline.6 However, 2 of the 6 patients receiving prophylactic doses of LMWH in our study had bleeding events, although neither

References (32)

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