RSS-Feed abonnieren
DOI: 10.1055/s-2007-966719
© Georg Thieme Verlag KG Stuttgart · New York
Incidence and clinical significance of hyperamylasemia after endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions: a prospective and controlled study
Publikationsverlauf
eingereicht 6 September 2006
akzeptiert 12 June 2007
Publikationsdatum:
30. Juli 2007 (online)
![](https://www.thieme-connect.de/media/endoscopy/200708/lookinside/thumbnails/10.1055-s-2007-966719-1.jpg)
Background and study aim: Acute pancreatitis as a complication of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic lesions is rarely observed. However, there is little information on the incidence of hyperamylasemia after EUS-FNA of the pancreas and its clinical significance. This study aimed to supply this lack of information.
Patients and methods: Patients who underwent EUS-FNA of a pancreatic lesion between October 2004 and October 2005 were studied prospectively. Exclusion criteria were: (i) platelet count under 50 000/mm3 and/or prothrombin time < 50 %; (ii) performance of surgery, endoscopic retrograde cholangiopancreatography (ERCP), a percutaneous biopsy attempt, or another invasive procedure within 7 days before EUS-FNA; (iii) lack of informed consent. Serum amylase levels were determined before and 8 and 24 h after the procedure. Hyperamylasemia was defined by amylase levels above 104 UI/L (and higher than baseline levels) 8 h after the procedure. Acute pancreatitis was defined by upper abdominal pain (with or without nausea and/or vomiting) accompanied by elevation of serum amylase or lipase to at least twice baseline levels.
Results: A total of 100 patients underwent EUS-FNA of a pancreatic lesion (58 men, 42 women; mean age 60 ± 13 years). Eleven patients (11 %) showed hyperamylasemia 8 h after the puncture (298 ± 293 UI/L, range 105 - 1044 UI/L), but only two of them developed acute mild pancreatitis after EUS-FNA. Hyperamylasemia was not related either to the type of lesion (cystic or solid) or to its location, the duration of the procedure, or the number of passes performed.
Conclusions: Pancreatitis after pancreatic EUS-FNA occurs in 2 % of patients, with some more cases of silent hyperamylasemia. This complication may have to be included in the information given to patients for their informed consent.
References
- 1 Jennings P E, Donald J J, Coral A. et al . Ultrasound-guided core biopsy. Lancet. 1989; 1 1369-1371
- 2 Brandt K R, Charboneau J W, Stephens D H. et al . CT- and US-guided biopsy of the pancreas. Radiology. 1993; 187 99-104
- 3 Zech C J, Helmberger T, Wichmann M W. et al . Large core biopsy of the pancreas under CT fluoroscopy control: results and complications. J Comput Assist Tomogr. 2002; 26 743-749
- 4 Mahnke D, Chen Y K, Antillon M R. et al . A prospective study of complications of endoscopic retrograde cholangiopancreatography and endoscopic ultrasound in an ambulatory endoscopy center. Clin Gastroenterol Hepatol. 2006; 4 924-930
- 5 Lopertido S, Angelini G P, Benedetti G. et al . Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc. 1998; 48 1-10
- 6 Bordas J M, Toledo-Pimentel V, Llach J. et al . Effects of bolus somatostatin in preventing pancreatitis after endoscopic pancreatography: results of a randomized study. Gastrointest Endosc. 1998; 47 230-234
- 7 Testoni P A, Bagnolo F, Caporuscio S, Lella F. Serum amylase measured four hours after endoscopic sphincterotomy is a reliable predictor of postprocedure pancreatitis. Am J Gastroenterol. 1999; 94 1235-1241
- 8 Cheng C L, Sherman S, Watkins J L. et al . Risk factors for post-ERCP pancreatitis: a prospective multicenter study. Am J Gastroenterol. 2006; 101 139-147
- 9 Chang K J, Nguyen P, Erickson R A. et al . The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc. 1997; 45 387-393
- 10 Faigel D O, Ginsberg G G, Bentz J S. et al . Endoscopic ultrasound-guided real time fine-needle aspiration biopsy of the pancreas in cancer patients with pancreatic lesions. J Clin Oncol. 1997; 15 1439-1443
- 11 Fritscher-Ravens A, Brand L, Knofel W T. et al . Comparison of endoscopic ultrasound-guided fine needle aspiration for focal pancreatic lesions in patients with normal parenchyma and chronic pancreatitis. Am J Gastroenterol. 2002; 97 2768-2775
- 12 Gress F, Gottlieb K, Sherman S, Lehman G. Endoscopic ultrasonography-guided fine-needle aspiration biopsy of suspected pancreatic cancer. Ann Intern Med. 2001; 134 459-464
- 13 Harewood G C, Wiersema M J. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol. 2002; 97 1386-1391
- 14 Frossard J L, Amouyal P, Amouyal G. et al . Performance of endosonography-guided fine needle aspiration and biopsy in the diagnosis of pancreatic cystic lesions. Am J Gastroenterol. 2003; 98 1516-1524
- 15 Gress F, Michael H, Gelrud D. et al . EUS-guided fine-needle aspiration of the pancreas: evaluation of pancreatitis as a complication. Gastrointest Endosc. 2002; 56 864-867
- 16 Wiersema M J, Vilmann P, Giovannini M. et al . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997; 112 1087-1095
- 17 Eloubeidi M A, Gress F G, Savides T J. et al . Acute pancreatitis after EUS-guided FNA of solid pancreatic masses: a pooled analysis from EUS centers in the United States. Gastrointest Endosc. 2004; 60 385-389
- 18 O’ Toole D, Palazzo L, Arotcarena R. et al . Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc. 2001; 53 470-474
- 19 Eloubeidi M A, Tamhane A, Varadarajulu S, Wilcox M. Frequency of major complications after EUS-guided FNA of solid pancreatic masses: a prospective evaluation. Gastrointest Endosc. 2006; 63 622-629
- 20 Bournet B, Migueres I, Delacroix M. et al . Early morbidity of endoscopic ultrasound: 13 years’ experience at a referral center. Endoscopy. 2006; 38 349-354
- 21 Buscarini E, de Angelis C, Arcidiacono P G. et al . Multicenter retrospective study on endoscopic ultrasound complications. Dig Liver Dis. 2006; 38 762-767
- 22 Wiersema M J, Vilmann P, Giovannini M. et al . Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology. 1997; 4 1087-1095
- 23 Cotton P B, Lehman G, Vennes J. et al . Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc. 1991; 37 383-393
- 24 Voss M, Hammel P, Molas G. et al . Diagnostic value of fine needle aspiration biopsy in the diagnosis of solid pancreatic tumors. Gut. 2000; 46 244-249
- 25 Lee L S, Saltzman J R, Bounds B C. et al . EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors. Clin Gastroenterol Hepatol. 2005; 3 231-236
- 26 Varadarajulu S, Eloubeidi M. Frequency and significance of acute intracystic hemorrhage during EUS-FNA of cystic lesions of the pancreas. Gastrointest Endosc. 2004; 60 631-635
- 27 Welch Y J, Sheedy P F, Johnson C D. et al . CT-guided biopsy: prospective analysis of 1000 procedures. Radiology. 1989; 171 493-496
- 28 Livraghi T, Damascelli B, Lombardi C, Spagridi I. Risk in fine needle aspiration biopsy. J Clin Ultrasound. 1983; 11 77-80
-
29 Smith E H.
Fine needle aspiration biopsy; are there any risks? . In: Holm HH, Kristenson JK (eds). Interventional ultrasound. Copenhagen; Munksgaard 1985: 169-177 - 30 Smith E H. Complications of percutaneous abdominal fine-needle biopsy. Radiology. 1991; 178 253-258
À. Ginès, MD, PhD
Endoscopy Unit
Institut de Malalties Digestives
Hospital Clinic
Villarroel 170
08036 Barcelona
Spain
Fax: +34-93-2279387
eMail: magines@clinic.ub.es