Preventive strategies for complications after endoscopic ultrasound-guided fine-needle biopsy

Abstract

In this editorial, we comment on the paper from Peruhova et al on this issue of World Journal of Gastointestinal Endoscopy. The major complications of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) include perforation, bleeding, infection, acute pancreatitis when sampling pancreatic lesions, bile peritonitis, needle tract seeding, and device-related malfunctions. The preventive strategies for complications following EUS-FNB include careful pre-procedural planning, technical efficiency during the procedure, and appropriate post-procedure care. In order to prevent the inadvertent perforation, one has to be careful about the presence of any esophageal stricture, diverticula, or anatomical abnormalities. The complication of bleeding can be minimized by the use of color Doppler to avoid puncturing intervening blood vessels, by limiting the number of passes, and by adhering to the guidelines to stop the anticoagulants and antiplatelets prior to the procedure. The risk of infection can be prevented by maintaining strict aseptic precautions, aspirating the cyst completely when present, and using antibiotic prophylaxis in patients with a high risk of infection, such as those with a pancreatic cyst. Acute pancreatitis can be prevented by minimizing the puncture of the main pancreatic duct and minimizing the number of needle passes. Bile peritonitis can be prevented by avoiding inadvertent puncture of the common bile duct or intrahepatic ducts when the target lesion is in close proximity to the bile duct. The needle tract seeding can be prevented by selecting the proper needle route in the possible resection field and by limiting the needle passes. EUS-FNB needs specific ethical considerations, which involve the balancing of the need for accurate histological diagnosis with patient safety, procedural risks, and informed consent. The proper use of suitable strategies to avoid complications will help the endosonographer to perform EUS-FNB safely and effectively.

Keywords: Endoscopic ultrasound-guided fine-needle biopsy; Complication; Perforation; Bleeding; Infection; Pancreatitis; Bile peritonitis; Needle tract seeding; Device-related malfunction; Preventive strategies

Core Tip: The major complications of endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) include perforation, bleeding, infection, acute pancreatitis when sampling pancreatic lesions, bile peritonitis, needle tract seeding where tumor cells are deposited along the needle track, and device-related malfunctions. The preventive strategies for complications following EUS-FNB include careful pre-procedural planning, technical efficiency during the procedure, and appropriate post-procedure care. EUS-FNB needs specific ethical considerations, which involve the balancing of the need for accurate histological diagnosis with patient safety, procedural risks, and informed consent. The proper use of suitable strategies to avoid complications will help the endosonographer to perform EUS-FNB safely and effectively.