Subscribe to RSS
DOI: 10.1055/a-2313-3991
Hemorrhage into the bile duct after endoscopic ultrasound-guided fine needle aspiration for pancreatic cancer
A 71-year-old man presented to our department with an elevated serum amylase level of 695 IU/L. Computed tomography revealed a cystic lesion measuring 26 mm in diameter in the pancreatic head ([Fig. 1]). Endoscopic ultrasound (EUS) identified a hypoechoic tumor measuring 15 mm in diameter adjacent to this multilocular cyst. The common bile duct (CBD) was compressed by the tumor without proximal dilation ([Fig. 2]). We performed EUS-guided fine needle aspiration (EUS-FNA) using a 22-gauge Franseen needle from the duodenal bulb in the long scope position. After three punctures, Doppler imaging revealed a turbulent flow signal in the CBD ([Fig. 3]). Subsequently, we confirmed bleeding from the papilla endoscopically ([Fig. 4]). Additionally, hyperechoic clots in the gallbladder were observed endosonographically ([Fig. 5]). The patient remained stable, with a gradual reduction in the turbulent flow signal. Thereafter, we performed endoscopic biliary drainage using a 5-Fr nasobiliary catheter to monitor hemobilia and found no rebleeding. The pathological diagnosis was adenocarcinoma. ([Video 1]).
Quality:
The incidence of iatrogenic hemobilia is reportedly increasing [1]. However, hemorrhage is a rare complication during EUS-FNA [2], and only two case reports of hemobilia after EUS-FNA have been documented [3] [4]. In our case, an impressive video of the turbulent flow signal by Doppler imaging was captured as a sign of hemobilia. Fortunately, hemobilia stopped spontaneously in this case. If the bleeding was severe, interventional radiology might have been needed. Despite taking precautions to determine a puncture route to avoid injuring intervening vessels and organs by B-mode and Doppler imaging, small arteries adjacent to the CBD might remain undetectable due to scope compression. To ensure early detection of adverse events following EUS-FNA, it is essential to assess for hemorrhage both endosonographically and endoscopically.
Endoscopy_UCTN_Code_CPL_1AL_2AD
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
Publication History
Article published online:
17 May 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Zhornitskiy A, Berr R, Han JY. et al. Hemobilia: Historical overview, clinical update, and current practice. Liver Int 2019; 39: 1378-1388
- 2 Eloubeidi MA, Tamhane A, Varadarajulu S. et al. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc 2006; 63: 622-629
- 3 Kawakubo K, Isayama H, Takahara N. et al. Hemobilia as a rare complication after endoscopic ultrasound-guided fine-needle aspiration for hilar cholangiocarcinoma. Endoscopy 2011; 43: E334-335
- 4 Horiuchi T, Shibata Y, Shinomiya W. et al. Biliary tract bleeding with obstructive jaundice after endoscopic ultrasound-guided fine-needle aspiration of a pancreatic head tumor. Clin J Gastroenterol 2020; 13: 116-119