Improving Quality and Safety in the Endoscopy Unit (On-Demand)

ASGE Adverse Events EUS

Pdf Summary

The American Society for Gastrointestinal Endoscopy's (ASGE) updated guideline reviews adverse events (AEs) linked to endoscopic ultrasound (EUS) and EUS-guided procedures. EUS is increasingly used for various diagnostic and therapeutic purposes, such as staging gastrointestinal cancers, assessing pancreatobiliary issues, and managing pancreatic fluid collections (PFCs). The guideline, based on data from 2000 to 2020, highlights different AEs and their predictors associated with EUS.<br /><br />Key findings reveal that AEs related to routine EUS are rare, but can include perforation and hemorrhage, especially when fine-needle aspiration or biopsy is involved. The incidence of serious complications like bleeding increases if patients are on antithrombotic medications or when procedures are done on lower gastrointestinal tracts. Infection is also a risk but more commonly associated with certain EUS procedures, such as sampling pancreatic cysts.<br /><br />EUS-guided therapeutic procedures often pose a higher risk of AEs compared to diagnostic EUS. For example, EUS-guided drainage of PFCs, especially with new developments like lumen-apposing metal stents (LAMS), involves a higher risk of bleeding. Other advanced procedures such as EUS-guided biliary drainage and gastroenterostomy have varying but generally higher rates of AEs, including stent migration and occlusion.<br /><br />The document emphasizes the need for higher quality research to address various gaps, such as predictors of AEs in EUS procedures, effectiveness and risks associated with emerging techniques, and optimal training for practitioners. It concludes by advising endoscopists to understand the risks associated with these procedures to improve patient communication and care outcomes, keeping in mind that clinical decisions must align with individual patient scenarios.

Keywords

ASGE guideline

endoscopic ultrasound

EUS adverse events

gastrointestinal cancers

pancreatic fluid collections

fine-needle aspiration

antithrombotic medications

lumen-apposing metal stents

EUS-guided biliary drainage

patient communication