Korean J Gastroenterol.  2018 Sep;72(3):135-140. 10.4166/kjg.2018.72.3.135.

The Risk Factors for Acute Pancreatitis after Endoscopic Ultrasound Guided Biopsy

Affiliations
  • 1Division of Gastroenterology, Palmetto General Hospital, Hialeah, FL, USA. eusgidoc@gmail.com
  • 2Division of Gastroenterology, University of Miami Sylvester Cancer Center, Miami, FL, USA.

Abstract

BACKGROUND/AIMS
The risk of developing pancreatitis induced by endoscopic ultrasound-guided fine needle aspiration (EUS FNA) is relatively small. However, patients undergoing sampling through the normal pancreatic parenchyma or the pancreatic duct may have a higher rate of pancreatitis. Here, we determine the factors associated with increased risk of acute pancreatitis in patients undergoing FNA through normal pancreatic parenchyma/pancreatic duct.
METHODS
In this prospective study at a tertiary cancer center, patients undergoing sampling through the pancreatic duct or ≥5 mm of the normal parenchyma between December 2013 and September 2017 were included. Post-EUS induced pancreatitis was diagnosed by the presence of abdominal pain with an amylase or lipase level higher than three times normal value.
RESULTS
A total of 712 patients underwent pancreatic EUS FNA. A total of 163 patients were included in the high-risk group. Mean age was 63 years, 82 females, mean number of needle-passes was 3.3 (range, 1-7). Fifteen patients (15/163, 9.2%) developed pancreatitis after EUS FNA through the pancreatic parenchyma compared with only one case among the control group (<5 mm of normal parenchyma) (0.18%, 1/549, p<0.0001). Several factors appeared to be associated with pancreatitis, including young age, solid lesion, and a recent history of acute pancreatitis. By logistic regression, a prior history of recent pancreatitis was the only statistically significant factor associated with post-EUS-guided biopsy pancreatitis (p=0.008).
CONCLUSIONS
Patients with a recent history of acute pancreatitis undergoing EUS FNA through 5 mm or more of the normal pancreatic parenchyma are at a much greater risk of acute pancreatitis.

Keyword

Pancreatitis; Biopsy; Endoscopy

MeSH Terms

Abdominal Pain
Amylases
Biopsy*
Endoscopic Ultrasound-Guided Fine Needle Aspiration
Endoscopy
Female
Humans
Lipase
Logistic Models
Pancreatic Ducts
Pancreatitis*
Prospective Studies
Reference Values
Risk Factors*
Ultrasonography*
Amylases
Lipase

Reference

1. Wang KX, Ben QW, Jin ZD, et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc. 2011; 73:283–290.
Article
2. Eloubeidi MA, Tamhane A, Varadarajulu S, Wilcox CM. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc. 2006; 63:622–629.
Article
3. Eloubeidi MA, Gress FG, Savides TJ, et al. Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United states. Gastrointest Endosc. 2004; 60:385–389.
4. Katanuma A, Maguchi H, Yane K, et al. Factors predictive of adverse events associated with endoscopic ultrasound-guided fine needle aspiration of pancreatic solid lesions. Dig Dis Sci. 2013; 58:2093–2099.
Article
5. Siddiqui AA, Shahid H, Shah A, et al. High risk of acute pancreatitis after endoscopic ultrasound-guided fine needle aspiration of side branch intraductal papillary mucinous neoplasm. Endosc Ultrasound. 2015; 4:109–114.
6. DeWitt J, McGreevy K, LeBlanc J, McHenry L, Cummings O, Sherman S. EUS-guided trucut biopsy of suspected nonfocal chronic pancreatitis. Gastrointest Endosc. 2005; 62:76–84.
Article
7. Jonkman EF, van Tuyl BA, Sanders FB, Haas LE. Severe acute pancreatitis after EUS-FNA of a pancreatic cyst: a rare, but serious complication. BMJ Case Rep. 2015; 05. 12. [Epub ahead of print].
Article
8. DiMaio CJ, Kolb JM, Benias PC, et al. Initial experience with a novel EUS-guided core biopsy needle (SharkCore): results of a large North American multicenter study. Endosc Int Open. 2016; 4:E974–E979.
Article
9. Catalano MF, Sahai A, Levy M, et al. EUS-based criteria for the diagnosis of chronic pancreatitis: the Rosemont classification. Gastrointest Endosc. 2009; 69:1251–1261.
Article
10. Jeong H, Park CS, Kim KB, et al. Predictors of malignancies in patients with inconclusive or negative results of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic masses. Korean J Gastroenterol. 2018; 71:153–161.
Article
11. Gress F, Michael H, Gelrud D, et al. EUS-guide fine-needle aspiration of the pancreas: evaluation of pancreatitis as a complication. Gastrointest Endosc. 2002; 56:864–867.
12. Fujii LL, Levy MJ. Basic techniques in endoscopic ultrasound-guided fine needle aspiration for solid lesions: adverse events and avoiding them. Endosc Ultrasound. 2014; 3:35–45.
Article
13. O'Toole D, Palazzo L, Arotçarena R, et al. Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc. 2001; 53:470–474.
14. Vege SS, Ziring B, Jain R, et al. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015; 148:819–822.
Article
Full Text Links
  • KJG
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr