4595 Acute extraluminal hemorrhage associated with eus fna: frequency and clinical significance.

Abstract

Background : Endoscopic ultrasound (EUS) and EUS guided fine needle aspiration (EUS-FNA) have been established as safe and accurate techniques for T and N staging of gastrointestinal tumors. Pancreatitis, infection, bleeding and perforation are complications of EUS-FNA. Acute extrluminal hemorrhage complicating EUS FNA has not been described. Aims : Describe and assess the frequency of acute extraluminal hemorrhage associated with EUS-FNA. Methods : From 9/98 to 11/99, 261 EUSFNA exams were performed. Indications for EUS-FNA were: pancreatic mass 25%, perigastric or celiac lymph nodes 22%, mediastinal lymph nodes 21%, pancreatic cysts 10%, periduodenal lymph nodes 5%, gastric wall lesion 3.8%, duodenal wall lesion 2.7%, perirectal lymph nodes 2.7%, and other 8%. All of the EUS-FNA were performed using the linear array echoendoscope. All patients had INR 100,000. Results : In 3 patients (1.1%, 95% CI: 0-2.4%) EUS-FNA was complicated by acute extraluminal hemorrhage observed as an expanding echopoor area developing around the biopsied lesion. In all patients this became apparent during the FNA procedure. Endoscopic pressure was applied to the site of the FNA for 15-20 minutes with no further expansion of the echopoor area. All patients were given a dose of intravenous antibiotics during or immediately after the procedure and then a 3-day course of oral antibiotics. The patients were observed in the recovery area for 2 hours with stable vital signs. Post procedure hematocrit was checked in 2 patients and was stable. In follow up visit after 1 to 7 days they reported no new symptoms. One patient subsequently underwent another EUS 3 weeks after EUS FNA and no residual evidence for bleeding was seen. None of these patients had been taking aspirin/NSAIDs within 3 days of the procedure. (See Table) Conclusions : 1) Acute extraluminal hemorrhage complicates EUS-FNA in 1% of cases and can be recognized as an expanding echopoor area surrounding the sampled lesion that was not present prior to performing the EUS-FNA. 2) The clinical significance of this hemorrhage is uncertain since it was self-limited in all three patients. 3) Discontinuation of the biopsy procedure and prophylactic antibiotic administration is recommended if extraluminal hemorrhage is observed.