Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review

Background: EUS-guided FNA (EUS-FNA) permits both morphologic and cytologic analysis of lesions within or adjacent to the GI tract. Although previous studies have evaluated the accuracy of EUS-FNA, little is known about the complications of EUS-FNA. Moreover, the frequency and severity of complications may vary from center to center and may be related to differences in individual experience. Objective: To systematically review the morbidity and mortality associated with EUS-FNA. Design: MEDLINE and EMBASE were searched to identify relevant English-language articles. Main Outcome Measurements: EUS-FNA-specific morbidity and mortality rates. Results: We identified 51 articles with a total of 10,941 patients who met our inclusion and exclusion criteria; the overall rate of EUS-FNA-specific morbidity was 0.98% (107/10,941). In the small proportion of patients with complications of any kind, the rates of pancreatitis (36/8246; 0.44%) and postprocedure pain (37/10,941; 0.34%) were 33.64% (36/107) and 34.58% (37/107), respectively. The mortality rate attributable to EUS-FNA-specific morbidity was 0.02% (2/10,941). Subgroup analysis showed that the morbidity rate was 2.44% in prospective studies compared with 0.35% in retrospective studies for pancreatic mass lesions (P = .000), whereas it was 2.33% versus 5.07% for pancreatic cysts (P = .036). Limitations: Few articles reported well-designed, prospective studies and few focused on overall complications after FUS-FNA. Conclusions: EUS-FNA-related morbidity and mortality rates are relatively low, and most associated events are mild to moderate in severity. (Gastrointest Endosc 2011;73:283-90.)