Peruhova M, Stoitsov V, Mirchev MB, Velikova T. Complication incidence after endoscopic ultrasound-guided fine needle biopsy: A single-center experience. World J Gastrointest Endosc 2026; 18(4): 111687 [DOI: 10.4253/wjge.v18.i4.111687]
Corresponding Author of This Article
Veselin Stoitsov, MD, PhD, Chief Physician, Division of Gastroenterology, University Hospital “Virgin Mary”, Zdrave Street 1, Burgas 8000, Bulgaria. vstoicov@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Observational Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Apr 16, 2026 (publication date) through Apr 16, 2026
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Peruhova M, Stoitsov V, Mirchev MB, Velikova T. Complication incidence after endoscopic ultrasound-guided fine needle biopsy: A single-center experience. World J Gastrointest Endosc 2026; 18(4): 111687 [DOI: 10.4253/wjge.v18.i4.111687]
Milena Peruhova, Veselin Stoitsov, Division of Gastroenterology, University Hospital “Virgin Mary,” Burgas 8000, Bulgaria
Milko Bozhidarov Mirchev, Division of Gastroenterology, University Hospital “Heart and Brain,” Burgas 8000, Bulgaria
Tsvetelina Velikova, Faculty of Medicine, Sofia University Saint Kliment Ohridski, Sofia 1407, Bulgaria
Author contributions: Peruhova M and Mirchev MB contributed to conceptualization; Stoitsov V contributed to methodology; Velikova T contributed to software, data curation, visualization, supervision, and formal analysis; Peruhova M, Stoitsov V, and Mirchev MB contributed to validation; Peruhova M and Stoitsov V contributed to investigation; Peruhova M contributed to resources and project administration; Peruhova M and Velikova T contributed writing the original draft; Stoitsov V and Mirchev MB contributed to reviewing and editing; All authors read and agreed to the published version of the manuscript.
Institutional review board statement: The study protocol received approval from the institutional research ethics board and was conducted in accordance with the principles of the Declaration of Helsinki, No. 001/2024.
Informed consent statement: All patients signed an informed consent statement before the procedure.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The dataset analyzed during the current study contains General Data Protection Regulation - protected patient information. Therefore, they are not publicly available but can be shared upon reasonable request to the corresponding author, in accordance with applicable data protection regulations.
Corresponding author: Veselin Stoitsov, MD, PhD, Chief Physician, Division of Gastroenterology, University Hospital “Virgin Mary”, Zdrave Street 1, Burgas 8000, Bulgaria. vstoicov@gmail.com
Received: July 7, 2025 Revised: August 26, 2025 Accepted: January 20, 2026 Published online: April 16, 2026 Processing time: 280 Days and 23 Hours
Abstract
BACKGROUND
Endoscopic ultrasound (EUS)-guided tissue acquisition, including both fine needle aspiration and fine needle biopsy (EUS-FNB), has been widely used to obtain samples from pancreatic and non-pancreatic lesions.
AIM
To summarize the incidence of complications from this procedure in a single endoscopic center.
METHODS
Data were retrospectively collected from patients who underwent diagnostic EUS at our endoscopy center over a 1-year period. We enrolled 88 cases with solid pancreatic or non-pancreatic lesions. All investigations were performed using the Olympus GF-UCT 180 Linear echoendoscope and the Hitachi Aloka 750 ultrasound system. A three-prong 22-gauge FNB needle was used in all cases.
RESULTS
A total of 88 EUS-FNB procedures were performed (48.9% female; mean age 67.8 ± 12.7 years). Complications occurred in 9.1% of cases, including bleeding (3.4%), perforation (4.5%), and pancreatitis (1.1%), with no infections or deaths. Endoscopist experience was significantly associated with complication rates (P = 0.032), with none reported for the most experienced operator. Although comorbidities were present in 90.9% of patients, they were not linked to complications (P = 0.214). Cardiovascular disease was identified as a significant predictor (P = 0.014). No differences in complications were observed across age- or sex-based clusters. A non-significant trend suggested more bleeding and pancreatitis with pancreatic targets and more perforations with non-pancreatic punctures.
CONCLUSION
Adverse events after EUS-FNB were higher than reported in literature; endoscopist experience and specific diagnoses, rather than overall comorbidity burden, were key predictors of complications.
Core Tip: This study highlighted that complications following fine needle biopsy are infrequent and primarily influenced by endoscopist experience rather than the overall burden of comorbidities. Although most patients had at least one comorbidity, no significant association was found between comorbidities and complication rates. Cardiovascular disease emerged as a specific predictor of risk while arterial hypertension showed a surprising negative association. These findings emphasize the importance of individual clinical factors and endoscopist expertise over cumulative comorbidity scores when assessing procedural risk and ensuring patient safety during fine needle biopsy.
