Review
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World J Gastroenterol. Sep 14, 2012; 18(34): 4659-4676
Published online Sep 14, 2012. doi: 10.3748/wjg.v18.i34.4659
Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications
Christian Jenssen, Maria Victoria Alvarez-Sánchez, Bertrand Napoléon, Siegbert Faiss
Christian Jenssen, Department of Internal Medicine, Krankenhaus Märkisch-Oderland GmbH, D15344 Strausberg, Germany
Maria Victoria Alvarez-Sánchez, Bertrand Napoléon, Department of Gastroenterology and Hepatology, Hopital Privé Jean Mermoz, F69008 Lyon, France
Siegbert Faiss, Department of Gastroenterology and Hepatology, Asklepios Klinik Barmbek, D22291 Hamburg, Germany
Author contributions: Jenssen C, Alvarez-Sánchez MV, Napoléon B and Faiss S contributed substantially to design and conception, performed the literature review and analyzed the literature data; Jenssen C provided the first draft of the paper, which was discussed and revised critically for intellectual content by Alvarez-Sánchez MV, Napoléon B and Faiss S; and all authors discussed the comments of the reviewers and approved the final version to be published.
Correspondence to: Christian Jenssen, MD, Department of Internal Medicine, Krankenhaus Märkisch-Oderland GmbH, Prötzeler Chaussee 5, D15344 Strausberg, Germany. c.jenssen@khmol.de
Telephone: +49-33-4152822 Fax: +49-33-45640302
Received: April 9, 2012
Revised: July 6, 2012
Accepted: July 18, 2012
Published online: September 14, 2012
Abstract

Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.

Keywords: Endoscopic ultrasonography; Endoscopic ultrasonography-guided fine-needle biopsy; Complications; Contraindications; Risk; Safety; Perforation; Bleeding; Infection; Acute pancreatitis