ASGE Therapeutic EUS for Advanced Endosonographers (On-Demand)

7_Patel_Therapeutic EUS

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Dr. Kal Patel discusses how to manage adverse events in therapeutic endoscopic ultrasound (EUS). He emphasizes the importance of anticipating, avoiding, and taking action to prevent adverse events. Common risks in EUS include needle puncture complications such as bleeding, perforation, unintentional organ embolization, and mis-deployment or dislodgement of lumen-apposing metal stents (LAMS).<br /><br />Pancreatitis is a known complication of EUS fine needle sampling and biopsy, with an incidence of 0.2-2.0%. The risk increases when the needle passes through more normal pancreas and ducts. Recent research has identified high-risk groups for pancreatitis, including females, young age, and prior pancreatitis. Needle tract seeding, with an incidence of 0.1-3.4%, has been reported but has not shown any differences in outcomes. Techniques such as flushing the needle between passes and using fine needle biopsy (FNB) instead of fine needle aspiration (FNA) may reduce this risk.<br /><br />In liver biopsies, bleeding can occur as a complication. Coil embolization is used to manage bleeding in EUS-guided interventions. Techniques to reduce coil embolization include proper placement within the gastric varices and avoiding excessive manipulation.<br /><br />LAMS is commonly used in draining pancreatic fluid collections (PFCs). However, adverse events are reported in 24.3% of cases. Techniques to reduce adverse events in PFC drainage include minimizing the time the stent is left in place, using a pigtail stent within the LAMS, and selecting the largest stent diameter possible.<br /><br />Other complications associated with LAMS include bleeding, stent migration, stent occlusion, and managing dislodged or buried stents. LAMS can also be used for gallbladder drainage and gastrojejunostomy. Mis-deployment of the adjoined flanges in LAMS can result in free perforation of the stomach or jejunum.<br /><br />Dr. Patel emphasizes the importance of being prepared for procedures and complications, as well as sharing adverse events with colleagues and learning from them to improve skills.

Keywords

adverse events

therapeutic endoscopic ultrasound

needle puncture complications

pancreatitis

needle sampling and biopsy

coil embolization

draining pancreatic fluid collections

stent migration

gallbladder drainage

skills improvement