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Interventional endoscopic ultrasonography: an overview of safety and complications

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Abstract

Background

In recent years, endoscopic ultrasonography (EUS)-guided techniques have been developed as alternatives to surgical, radiologic, or conventional endoscopic approaches for the treatment or palliation of several digestive diseases. The use of EUS guidance allows the therapeutic area to be targeting more precisely, with a possible clinical benefit and less morbidity. Nevertheless, the risks persist and must be taken into consideration. This review gives an overview of the complications observed with the most established procedures of therapeutic EUS.

Methods

The PubMed and Embase databases were used to search English language articles on interventional EUS. The studies considered for inclusion were those reporting on complications of EUS-guided celiac plexus block (EUS-CPB), EUS-guided celiac plexus neurolysis (EUS-CPN), drainage of fluid pancreatic and pelvic collections, and EUS-guided biliary and pancreatic drainage (EUS-BD and EUS-PD). Variations in methodology and design in most studies made a thorough statistical analysis difficult. Instead, a frequency analysis of complications and a critical discussion were performed.

Results

Although EUS-guided celiac plexus injection causes mainly mild and transient complications, growing experience shows that EUS-CPN is not as benign a procedure as previously thought. Most of the major complications have been observed in patients with chronic pancreatitis. The findings show that EUS-guided drainage of fluid collections is a safe procedure. Complications occur more often after the drainage of pancreatic abscesses and necrosis. Although the heterogeneity of studies dealing with pancreatobiliary drainage makes the evaluation of risks after these procedures difficult, complications after EUS-BD and EUS-PD are relatively frequent and can be severe. The technical complexity and the lack of specifically designed devices may account for their complication rates.

Conclusions

Clinicians can consider EUS-guided celiac injection and EUS-guided drainage of fluid collections to be safe alternatives to surgical and radiologic interventions. Well-designed prospective trials are needed to assess the risks of EUS-BD and EUS-PD accurately before they are broadly advocated after a failed endoscopic retrograde cholangiopancreatography (ERCP).

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Disclosures

María-Victoria Alvarez-Sánchez, Christian Jenssen, Siegbert Faiss, and Bertrand Napoléon have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Hôpital Privé Jean Mermoz, 55 Avenue Jean Mermoz, 69008, Lyon, France

    María Victoria Alvarez-Sánchez & Bertrand Napoléon

  2. Department of Internal Medicine, Krankenhaus Märkisch-Oderland, Wriezen, Strausberg, Germany

    Christian Jenssen

  3. Department of Gastroenterology and Hepatology, Asklepios Klinik Barmbek, Hamburg, Germany

    Siegbert Faiss

Authors
  1. María Victoria Alvarez-Sánchez
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  2. Christian Jenssen
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  3. Siegbert Faiss
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  4. Bertrand Napoléon
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Correspondence to María Victoria Alvarez-Sánchez.

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Alvarez-Sánchez, M.V., Jenssen, C., Faiss, S. et al. Interventional endoscopic ultrasonography: an overview of safety and complications. Surg Endosc 28, 712–734 (2014). https://doi.org/10.1007/s00464-013-3260-5

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  • DOI: https://doi.org/10.1007/s00464-013-3260-5

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