4593 A prospective assessment of complications and patient acceptance of upper gi endoscopic ultrasonography- a multicenter study in 2500 patients.

Abstract

Background : Whereas a multitude of literature exists on the accuracy of endoscopic ultrasonography (EUS), prospective data on complications and patient acceptance of this procedure are sparse. Patients and Methods : Multicenter (37 German centers) assessment of indications, duration, premedication and complications of upper GI EUS. Patients were asked to answer a questionnaire about their tolerance of the procedure after EUS, when sedation was no longer effective. Results : The study was completed in autumn 1999. Data on 2508 of patients are analyzable (59% male, median age: 60,2 years). Indications were in the esophagus in 465, stomach in 658 and in the pancreatobiliary tract in 907 cases. Tumor diagnosis/exclusion (n= 1079), tumor staging (n=619), diagnosis of submucosal lesions (n=174) were predominant reasons for EUS. The mean duration of EUS was 19,3 minutes with only little difference between esophagogastric (18.5 min) and pancreatobiliary indications (20.5 min). 92% of patients received some form of sedation, mostly benzodiazepines. Complications were recorded in 122 cases (4.9%), but 94% of those consisted of oxygen desaturation (mean of 1.6 episodes, mean duration 61,6 sec), all of them without obvious clinical significance. Further complications were 5 minor cardiovascular events (tachy-/bradycardia, hypertension) and one case of respiratory depression (EUS interrupted, no resuscitation necessary) as well as one case of minor bleeding, not requiring endoscopic hemostasis. No perforation was encountered. EUS was rated as tolerable by 54% of patients (41% of patients did not recall the examination) and intolerable by 5%. When asked, 81% of patients would repeat EUS, a further 17% with more sedation. Conclusions : EUS can be performed within a reasonable time frame and mostly under sedation but with a very low rate of clinically significant omplications. Patient acceptance of EUS is excellent.