ASGE guideline: Complications of EUS

For the following points: (A), prospective controlled trials; (B), observational studies; (C), expert opinion. • EUS uses instruments that have different mechanical and optical properties than standard forward-viewing endoscopes and require special care in their use to minimize complications. (C) • Patients undergoing EUS by experienced endosonographers are not at increased risk for perforation compared with standard endoscopy. Lack of operator experience, advanced patient age, difficulty with esophageal intubation, and dilation of esophageal cancers may all be risk factors for perforation. (B) • Most complications of EUS are associated with performing FNAs. (B) • The risk of bacteremia after EUS-FNA is low. (A) • Patients undergoing EUS-FNA of solid lesions or lymph nodes do not require antibiotic prophylaxis. One exception may be transrectal FNA, although data supporting routine antibiotic use do not exist. (B) • Patients who undergo EUS-FNA of cystic lesions (pancreatic or mediastinal) are at increased risk of fever and possibly infectious complications. Antibiotic prophylaxis is warranted in this setting. (B) • Patients undergoing EUS-FNA of the pancreas have a 1% to 2% risk of pancreatitis. (B) • Clinically significant bleeding and bile peritonitis are rare complications of EUS-FNA. (B) • EUS-guided celiac plexus blockade or neurolysis carries a small risk of major complications, but the safety appears to be comparable with percutaneous celiac plexus blockade or neurolysis. (B).