Acute pancreatitis after EUS-guided FNA of solid pancreatic masses

Abstract

Background The aim of this study was to determine the frequency and the severity of pancreatitis after EUS-guided FNA of solid pancreatic masses. A survey of centers that offer training in EUS in the United States was conducted.

Methods A list of centers in which training in EUS is offered was obtained from the Web site of the American Society for Gastrointestinal Endoscopy. Designated program directors were contacted via e-mail. The information requested included the number of EUS-guided FNA procedures performed for solid pancreatic masses, the number of cases of post-procedure pancreatitis, and the method for tracking complications. For each episode of pancreatitis, technical details were obtained about the procedure, including the location of the mass, the type of fine needle used, the number of needle passes, and the nature of the lesion.

Results Nineteen of the 27 programs contacted returned the questionnaire (70%). In total, 4909 EUS-guided FNAs of solid pancreatic masses were performed in these 19 centers over a mean of 4 years (range 11 months to 9 years). Pancreatitis occurred after 14 (0.29%): 95% CI[0.16, 0.48] procedures. At two centers in which data on complications were prospectively collected, the frequency of acute pancreatitis was 0.64%, suggesting that the frequency of pancreatitis in the retrospective cohort (0.26%) was under-reported (p = 0.22). The odds that cases of pancreatitis would be reported were 2.45 greater for the prospective compared with the retrospective cohort (95% CI[0.55, 10.98]). The median duration of hospitalization for treatment of pancreatitis was 3 days (range 1-21 days). The pancreatitis was classified as mild in 10 cases, moderate in 3, and severe in one; one death (proximate cause, pulmonary embolism) occurred after the development of pancreatitis in a patient with multiple comorbid conditions.

Conclusions EUS-guided FNA of solid pancreatic masses is infrequently associated with acute pancreatitis. The procedure appears to be safe when performed by experienced endosonographers. The frequency of post EUS-guided FNA pancreatitis may be underestimated by retrospective analysis.

EUS-guided FNA (EUS-FNA) has emerged as an effective technique for tissue diagnosis in patients suspected to have pancreatic cancer.1., 2., 3., 4., 5. and 6. EUS-FNA has replaced ERCP and brush cytology as the endoscopic procedure of choice because of its higher diagnostic yield and a perception that EUS-FNA is associated with a lower risk of post-procedure pancreatitis. However, there are few reports of experience with EUS-FNA of solid pancreatic masses that included data on complications, e.g., acute pancreatitis.6., 7., 8., 9. and 10. Data on complications of EUS-FNA in general, and EUS-FNA of the pancreas in particular, are relatively scarce. The results of one study suggest that patients with a history of recent acute pancreatitis are more likely to develop pancreatitis after EUS-FNA8; however, the risk factors for pancreatitis related to EUS-FNA of the pancreas are unknown. In addition, the frequency and the severity of pancreatitis might vary from center to center and could be related to experience with performance of EUS-FNA. To obtain a more global perspective of the magnitude of acute pancreatitis as a complication of EUS-FNA of solid pancreatic masses, a survey was conducted of endosonographers at centers in the United States in which training in EUS is offered.