P-THER-10: Complications encountered during interventional endoscopic ultrasound - a tertiary care center experience

BACKGROUND AND OBJECTIVES: Interventional endoscopic ultrasound (EUS) includes fine needle aspiration (FNA), pancreatic cystogastrostomy, aspiration of cystic cavity or collection, hepaticogastrostomy, and coiling. It is considered safe. This study was undertaken to note frequency of various complications that arose with interventional EUS at our center. METHODS: This was a retrospective cohort study done at a tertiary level referral center. Records of all patients who underwent EUS intervention over a period of 6 years (October 2010 to September 2016) were reviewed. Procedure-related minor adverse events such as throat pain and abdominal pain were noted. Complications were defined as acute pancreatitis, perforation, mucosal tear, hepatic encephalopathy, pneumomediastinum, pneumoperitoneum, peritoneal leak, bleeding, hematoma, and fever requiring hospital admission. RESULTS: A total of 4654 EUS were done, of which 2030 intervention performed. Of these, 1780 were EUS FNA, 146 aspiration, 64 cystogastrostomy, and 40 others. Procedure-related minor adverse events were noted in 42% cases (throat pain - 31% and abdominal pain - 11%). Complications were observed in 35 patients (1.72%); minor mucosal bleeding (12), mild acute pancreatitis (5), asymptomatic duodenal hematoma (4), fever requiring hospitalization (3), duodenal perforations (2), cervical esophageal tear (2), mild hepatic encephalopathy (2), pneumomediastinum (1), pneumoperitoneum (1), bleeding from gastroduodenal artery (1), cystogastostomy site bleeding (1), and peritoneal leak (1). All the complications were managed conservatively except duodenal perforations which required surgery and peritoneal leak requiring drain placement percutaneously. On subgroup analysis, there were significant fewer complications with operator experience of >1000 EUS (P = 0.002). CONCLUSION: EUS intervention is a safe procedure, especially in experienced hands.