Acute extraluminal hemorrhage associated with EUS-guided fine needle aspiration: frequency and clinical significance

Gastrointest Endosc. 2001 Feb;53(2):221-5. doi: 10.1067/mge.2001.111391.


Background: Complications with EUS-guided fine needle aspiration cytology (EUS-guided FNA) are rare and include perforation, infection, pancreatitis, and intraluminal bleeding. To date, the ultrasound appearance and clinical significance of perilesional bleeding during EUS-guided FNA have not been described. The aim of this study was to analyze the frequency of acute extraluminal hemorrhage associated with EUS-guided FNA.

Methods: From September 1998 to October 1999 EUS-guided FNA was performed during 227 of 1104 EUS procedures. Patient follow-up and complications were recorded and retrospectively analyzed.

Observations: Three patients were identified with acute extraluminal hemorrhage at the site of the aspiration during EUS (frequency 1.3%: 95% CI [0%, 2.8%]). The bleeding manifested as an expanding echopoor region adjacent to the sampled lesion. No clinically recognizable sequela arose from the bleeding. All patients were treated with a short course of antibiotics and outpatient observation. Preprocedure coagulation and platelet assessment did not predict which patients were at risk for this complication.

Conclusion: Acute extraluminal hemorrhage occurring during EUS-guided FNA is a rare complication with a characteristic ultrasound appearance. Recognition of this event might be important to allow the endoscopist to terminate the procedure and thereby minimize the potential for more serious bleeding.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adolescent
  • Aged
  • Aged, 80 and over
  • Biopsy, Needle / adverse effects*
  • Biopsy, Needle / methods
  • Endosonography*
  • Female
  • Gastrointestinal Hemorrhage / epidemiology
  • Gastrointestinal Hemorrhage / etiology*
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies