Gut Liver.  2018 May;12(3):353-359. 10.5009/gnl17293.

A Prospective Multicenter Study Evaluating Bleeding Risk after Endoscopic Ultrasound-Guided Fine Needle Aspiration in Patients Prescribed Antithrombotic Agents

  • 1Department of Gastroenterology and Hepatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan.
  • 2Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.
  • 3Department of Gastroenterology, Tomakomai City Hospital, Tomakomai, Japan.
  • 4Department of Medical Oncology and Hematology, Sapporo Medical University, Sapporo, Japan.
  • 5Department of Gastroenterology, Japanese Red Cross Kitami Hospital, Kitami, Japan.
  • 6Department of Gastroenterology, NTT East Sapporo Hospital, Sapporo, Japan.
  • 7Department of Gastroenterology, Kushiro Rosai Hospital, Kushiro, Japan.
  • 8Department of Gastroenterology, Obihiro Kosei Hospital, Obihiro, Japan.
  • 9Department of Gastroenterology, Keiwakai Ebetsu Hospital, Ebetsu, Japan.
  • 10Department of Gastroenterology and Hepatology, Hakodate City Hospital, Hakodate, Japan.
  • 11Department of Gastroenterology, Abashiri Kosei Hospital, Abashiri, Japan.
  • 12Department of Gastroenterology, Oji General Hospital, Tomakomai, Japan.
  • 13Department of Gastroenterology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan.


Although the risk of bleeding after endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is low, the safety of EUS-FNA in patients prescribed antithrom-botic agents is unclear. Therefore, this study evaluated the incidence of bleeding after EUS-FNA in those patients.
Between September 2012 and September 2015, patients who were prescribed antithrombotic agents underwent EUS-FNA at 13 institutions in Japan were prospectively enrolled in the study. The antithrombotic agents were managed according to the guidelines of the Japanese Gastrointestinal Endoscopy Society. The rate of bleeding events, thromboembolic events and other complications within 2 weeks after EUS-FNA were analyzed.
Of the 2,629 patients who underwent EUS-FNA during the study period, 85 (62 males; median age, 74 years) patients were included in this stduy. Two patients (2.4%; 95% confidence interval [CI], 0.6% to 8.3%) experienced bleeding events. One patient required surgical intervention for hemothorax 5 hours after EUS-FNA, and the other experienced melena 8 days after EUS-FNA and required red blood cell transfusions. No thromboembolic events occurred (0%; 95% CI, 0.0% to 4.4%). Three patients (3.5%; 95% CI, 1.2% to 10.0%) experienced peri-puncture abscess formation.
The rate of bleeding after EUS-FNA in patients prescribed antithrombotic agents might be considerable.


Endoscopic ultrasound-guided fine needle aspiration; Hemorrhage; Fibrinolytic agents

MeSH Terms

Asian Continental Ancestry Group
Endoscopic Ultrasound-Guided Fine Needle Aspiration*
Endoscopy, Gastrointestinal
Erythrocyte Transfusion
Fibrinolytic Agents*
Prospective Studies*
Fibrinolytic Agents
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