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

Table 1 Clinical indications and applications of endoscopic ultrasound-guided fine-needle biopsy

Clinical indications according to the lesion type

Pancreatic lesions: Pancreatic solid lesions (e.g., adenocarcinoma, neuroendocrine tumors); pancreatic cystic lesions; autoimmune pancreatitis

Lymph nodes: Mediastinal lymphadenopathy; abdominal lymphadenopathy

Gastrointestinal subepithelial tumors

Liver lesions: Hepatocellular carcinoma; metastases; parenchymal liver disease

Biliary obstruction: Bile duct strictures

Gallbladder lesions

Retroperitoneal masses

Adrenal gland masses

Splenic lesions

Peritoneal nodules

Clinical applications as a diagnostic tool in the following clinical settings

Requirement of histologic architecture (e.g., pancreatic neuroendocrine tumors, autoimmune pancreatitis, gastrointestinal stromal tumor, parenchymal liver disease)

Requirement of tissue specimens for additional testing (e.g., immunohistochemical or molecular genetic testing)

Unavailability of rapid on-site evaluation (ROSE)

Non-diagnostic cytology from FNA of the lesion

ROSE: Rapid on-site evaluation: FNA: Fine needle aspiration.

Table 2 Incidence and risk factors of complications after endoscopic ultrasound-guided procedure[8]

Complications	Incidence (%)	Risk factors
Perforation	0.02-0.08	Trainee involvement, operator inexperience, older patient, history of difficult esophageal intubation, presence of esophageal malignancy, cervical spine osteophytes
Bleeding	0.13-0.69	Antiplatelets, anticoagulants, low-molecular-weight heparins, fiducial placement
Infection	0.4-1.7	Sampling of pancreatic cyst or mediastinum
Pancreatitis	0.44-0.92	Fiducial placement