Needle fracture during endoscopic ultrasound-guided fine needle aspiration using a needle with a side hole

Abstract

Background and study aims Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is widely performed to obtain pathological evidence from several parts of the body. Major complications of EUS-FNA are bleeding, pancreatitis, and abdominal pain. Needle fracture is a rare complication of EUS-FNA and only a few relevant reports are available. Here, we report a case of needle fracture during EUS-FNA using a needle with a side hole. A 61-year-old man underwent EUS-FNA of the uncinate process of the pancreas to confirm malignancy. A 20-gauge needle with a side hole was used to puncture the mass from the first part of the duodenum. The needle fracture occurred at the side hole during the third passage, and the fragment remained in the pancreas. Fortunately, the patient did not exhibit any symptoms due to the needle fragment. This case indicates that repeated puncture using the same needle with a side hole might increase risk of needle fracture during EUS-FNA. It is important to inform clinicians about the potential risk of needle fracture, particularly given the increasing number of EUS-FNAs being performed.

• References

• 1 Vilmann P, Jacobsen GK, Henriksen FW. et al. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc 1992; 38: 172-173
• 2 Wang KX, Ben QW, Jin ZD. et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73: 283-290
• 3 Dhir V, Isayama H, Itoi T. et al. Endoscopic ultrasonography-guided biliary and pancreatic duct interventions. Dig Endosc 2017; 29: 472-485
• 4 Siddiqui UD, Rossi F, Rosenthal LS. et al. EUS-guided FNA of solid pancreatic masses: a prospective, randomized trial comparing 22-gauge and 25-gauge needles. Gastrointest Endosc 2009; 70: 1093-1097
• 5 Adamowicz B, Manière T, Déry V. et al. Needle fracture during endoscopic ultrasound-guided fine-needle aspiration of suspicious thoracic lymph nodes. Case Rep Med 2016; 2016: 2526789
• 6 El HajjII, Gromski MA, Lehman GA. et al. Accidental fracture of an EUS-FNA needle. Gastrointest Endosc 2018; 87: 891-893
• 7 DeWitt J, Sherman S, Lillemoe KD. Fracture of an EUS-guided FNA needle during an attempted rendezvous for an inaccessible pancreatic duct. Gastrointest Endosc 2011; 73: 171-173
• 8 Asano F, Aoe M, Ohsaki Y. et al. Complications associated with endobronchial ultrasound-guided transbronchial needle aspiration: a nationwide survey by the Japan Society for Respiratory Endoscopy. Respir Res 2013; 14: 50
• 9 Maciel MJ, Tyng CJ, Barbosa PN. et al. Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications. Radiol Bras 2014; 47: 269-274
• 10 Shaikh H, Thawani J, Pukenas B. Needle-in-needle technique for percutaneous retrieval of fractured biopsy needle during CT-guided biopsy of the thoracic spine. Interv Neuroradiol 2014; 20: 646-649