Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review

doi:10.1016/j.gie.2010.10.045

Gastrointestinal Endoscopy

Volume 73, Issue 2, February 2011, Pages 283-290

https://doi.org/10.1016/j.gie.2010.10.045 Get rights and content

Background

EUS-guided FNA (EUS-FNA) permits both morphologic and cytologic analysis of lesions within or adjacent to the GI tract. Although previous studies have evaluated the accuracy of EUS-FNA, little is known about the complications of EUS-FNA. Moreover, the frequency and severity of complications may vary from center to center and may be related to differences in individual experience.

Objective

To systematically review the morbidity and mortality associated with EUS-FNA.

Design

MEDLINE and EMBASE were searched to identify relevant English-language articles.

Main Outcome Measurements

EUS-FNA-specific morbidity and mortality rates.

Results

We identified 51 articles with a total of 10,941 patients who met our inclusion and exclusion criteria; the overall rate of EUS-FNA-specific morbidity was 0.98% (107/10,941). In the small proportion of patients with complications of any kind, the rates of pancreatitis (36/8246; 0.44%) and postprocedure pain (37/10,941; 0.34%) were 33.64% (36/107) and 34.58% (37/107), respectively. The mortality rate attributable to EUS-FNA-specific morbidity was 0.02% (2/10,941). Subgroup analysis showed that the morbidity rate was 2.44% in prospective studies compared with 0.35% in retrospective studies for pancreatic mass lesions (P = .000), whereas it was 2.33% versus 5.07% for pancreatic cysts (P = .036).

Limitations

Few articles reported well-designed, prospective studies and few focused on overall complications after EUS-FNA.

Conclusions

EUS-FNA-related morbidity and mortality rates are relatively low, and most associated events are mild to moderate in severity.

Section snippets

Materials and methods

The PubMed and EMBASE databases were searched for all clinical trials published in English from January 1966 to December 2007 that mentioned the search terms “endoscopic ultrasound” or “endosonography,” “biopsy,” and “fine-needle” or “fine-needle aspiration.” Studies that enrolled at least 10 participants who had undergone EUS-FNA were included, and the titles and abstracts of each were reviewed by 2 independent investigators (K.-X.W., Z.L.). Of 282 citations identified by title and abstract,

Results

A total of 282 related articles were identified by using our search terms (Fig. 1). Of these, 221 were excluded after a review of the titles and abstracts, and 10 were excluded after reading the full text. Ultimately, 51 articles met our inclusion and exclusion criteria.2, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 Of these, 20 were

Discussion

To our knowledge, this study is the first systematic analysis of EUS-FNA–related morbidity and mortality that includes so many patients and almost all organs targeted by EUS-FNA. The cumulative EUS-FNA morbidity rate in the 10,941 patients enrolled in 51 studies was 0.98%. Pain (34%) and pancreatitis (33%) were the most frequent complications, followed by bleeding (13%) and fever episodes (11%), with perforation accounting for only 2% of complications. The overall mortality rate was 0.02%.

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: DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

: See CME section; p. 345

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Original articleClinical endoscopyAssessment of morbidity and mortality associated with EUS-guided FNA: a systematic review

Background

Objective

Design

Main Outcome Measurements

Results

Limitations

Conclusions

Section snippets

Materials and methods

Results

Discussion

Gastrointest Endosc

Gastroenterology

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Clin Gastroenterol Hepatol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Clin Gastroenterol Hepatol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Am J Gastroenterol

Am J Gastroenterol

Clin Gastroenterol Hepatol

Gastroenterology

Gastrointest Endosc

Chest

Am J Gastroenterol

Am J Gastroenterol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

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Gastrointest Endosc

Am J Gastroenterol

Original article
Clinical endoscopy
Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review