超声内镜引导下细针穿刺抽吸胰腺肿块的主要并发症发生率:一项前瞻性研究

Background:EUS-guided FNA is effective for establishing tissue diagnosis in suspected pancreatic cancer.However,data on the frequency of major complications following EUS-FNA are limited.Objective:To evaluate the frequency of major complications after EUS-FNA of solid pancreatic masses.Design:Prospective cohort study.Setting:Tertiary University based referral center for pancreatico-biliary disorder.Patients:Consecutive patients who underwent EUS-FNA of a solid pancreatic over a 42-month period.All immediate complications were recorded by the endosonographer.Late complications were assessed at 72 hours and at 30-days after the procedure.Main Outcomes Measurements:Major complications were defined as acute pancreatitis,bleeding,infection,perforation,use of reversal medication,hospitalization or death.Results:A total of 355 consecutive patients with a solid pancreatic mass underwent EUS-FNA.Major complications were encountered in 9 patients(2.54%,95%CI 1.17-4.76).Acute pancreatitis occurred in 3 of 355(0.85 %,95%CI 0.17-2.45);2 patients were hospitalized,and 1 patient recovered with outpatient analgesics.Three patients were admitted for severe pain after the procedure;all were treated with analgesics and subsequently discharged with no sequela.Two patients(0.56%,95%CI 0.07-2.02)developed fever and were admitted for intravenous antibiotics;1 patient recovered with intravenous antibiotics and the other required surgical debridement for necrosis.One patient required the use of reversal medication.Overall,1.97%(95%CI 0.80-4.02)of the patients were hospitalized for complications(range 1-16 days).None of the patients experienced clinically significant hemorrhage,perforation,or death.No clear predisposing risk factors were identified.Limitations:Lack of surgical gold standard and referral to a tertiary center.Conclusions:EUS-FNA of solid pancreatic masses infrequently leads to major complications.Our results can be used by endosonographers to counsel patients before EUS-FNA of solid pancreatic masses.

超声内镜对胰胆管疾病患儿评估的影响

Background: While the role of EUS in the evaluation of pancreaticobiliary (PB) disorders in adults is well established, its utility in children remains unproven. This pros-pective study evaluates the feasibility, the safety, and the impact of EUS in the evaluation of PB disorders in children. Methods: All children (< 18 years)referred for ERCP for evaluation of suspected PB disorders who underwent EUS before scheduled ERCP. The main outcome measure was to evaluate the impact of EUS in the evaluation of PB disorders in children. EUS was considered to have a significant impact if a new diagnosis was established or if the findings altered subsequent management. Results: Fourteen patients (mean age 13 years; range 5- 17 years) underwent 15 EUS procedures over a 3-year period. Main indications were the following: acute or recurrent pancreatitis (6 patients), suspected biliary obstruction (5), and abdominal pain suggestive of PB origin (3). EUS diagnosed chronic pancreatitis (3 patients), idiopathic fibrosing pancreatitis (2), carcinoid tumor (1), pancreatic pse-udocyst (1), pancreas divisum (1), choledocholithiasis (1), duodenal duplication cyst (1), and normal (4). Dia-gnosis of idiopathic fibrosing pancreatitis and carcinoid tumor was established by EUS-guided FNA. The procedure was successful in all patients, and no complications were encountered. EUS had an impact on patient management in 93% of cases: established new diagnosis (10), precluded need for ERCP (9), and provided additional information that facilitated focused endotherapy (4). A limitation was the small number of enrolled patients and absence of long-term clinical follow-up. Conclusions: EUS and EUS-guided FNA are feasible, safe, and have significant impact that alters subsequent management in the majority of children with PB disorders. Further studies and dissemination of information is required to facilitate its increased application in children.