ASGE Therapeutic EUS for Advanced Endosonographers (Live and Virtual)

7_Patel_Therapeutic EUS

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In a presentation by Dr. Kal Patel, the management of adverse events in therapeutic EUS (endoscopic ultrasound) is discussed. Adverse events are common in therapeutic EUS procedures, and it is important for physicians to anticipate, avoid, and act in response to these events. Some of the risks associated with EUS procedures include bleeding, perforation, unintentional organ puncture, embolization, and complications related to the use of lumen apposing metal stents (LAMS).<br /><br />Pancreatitis is a potential adverse event in EUS fine needle sampling and biopsy. The incidence of pancreatitis is reported to be between 0.2-2.0%, with a higher risk in patients with IPMN (intraductal papillary mucinous neoplasm) compared to solid masses. Factors that increase the risk of pancreatitis include passing the needle through more normal pancreas and ducts, but there is no difference between fine needle aspiration (FNA) and fine needle biopsy (FNB) in terms of risk. The use of rectal indomethacin has not been supported by data.<br /><br />Needle tract seeding is another potential adverse event in EUS fine needle sampling, with an incidence of 0.1-3.4%. However, there is no difference in outcomes compared to procedures without seeding. Bleeding after fine needle biopsy in the liver is also a possible complication.<br /><br />Techniques to reduce adverse events in EUS-guided coil embolization of gastric varices are discussed. Lumen apposing metal stents (LAMS) are used for pancreatic fluid collections (PFCs). However, there is a 24.3% adverse event rate associated with LAMS. Techniques to reduce adverse events in PFC drainage include using the largest stent diameter possible, placing a pigtail stent within the LAMS, and selecting the stomach over the duodenum.<br /><br />Other procedures that are mentioned include the management of bleeding within PFCs, the replacement of a dislodged LAMS, removal of a buried LAMS, LAMS for gallbladder drainage, and LAMS for gastrojejunostomy. Mis-deployment of flanges during LAMS procedures is a concern, with up to 10-25% of cases experiencing free perforation.<br /><br />Overall, it is important for physicians to be prepared for adverse events in therapeutic EUS procedures and to share experiences and complications with colleagues to improve skills and outcomes.

Keywords

adverse events

therapeutic EUS

bleeding

perforation

lumen apposing metal stents

pancreatitis

needle tract seeding

coil embolization

PFC drainage

flange mis-deployment