Risk of adverse events associated with upper and lower endoscopic ultrasound: a population-based cohort study

Roshan Razik; Paul D James; Rishad Khan; Courtney Maxwell; Yibing Ruan; Nauzer Forbes; Anita Williams; Divine Tanyingoh; Darren R Brenner; Gilaad G Kaplan; Robert J Hilsden; Steven J Heitman

doi:10.1055/a-1512-9341

Risk of adverse events associated with upper and lower endoscopic ultrasound: a population-based cohort study

Endosc Int Open. 2021 Aug 23;9(9):E1427-E1434. doi: 10.1055/a-1512-9341. eCollection 2021 Sep.

Authors

Roshan Razik¹, Paul D James², Rishad Khan², Courtney Maxwell³, Yibing Ruan⁴, Nauzer Forbes^{3

5}, Anita Williams⁶, Divine Tanyingoh³, Darren R Brenner^{4

5}, Gilaad G Kaplan^{3

5}, Robert J Hilsden^{3

5}, Steven J Heitman^{3

5}

Affiliations

¹ Cleveland Clinic Akron General, Akron, Ohio, United States.
² Department of Medicine, University Health Network, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.
³ Department of Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
⁴ Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada.
⁵ Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
⁶ Analytics, Data Integration, Measurement and Reporting, Alberta Health Services, Calgary, Alberta, Canada.

Abstract

Background and study aim Endoscopic ultrasound (EUS) enables diagnostic evaluation and therapeutic interventions but is associated with adverse events. We conducted a population-based cohort study to determine the risk of adverse events for upper and lower EUS with and without fine-needle aspiration (FNA). Patients and methods All adults who underwent EUS and resided in Calgary in 2007-2013 were included. Endoscopy and provincial databases were used to identify EUS procedures, unplanned emergency department visits, and hospital admissions within 30 days of the procedures, which were then characterized through formal chart review. Adverse events were defined a priori and classified as definitely, possibly, or not related to EUS. The primary outcome was 30-day risk of adverse events classified as definitely or possibly related to EUS. Univariable and multivariable analyses were conducted with risk factors known to be associated with EUS adverse events. Results 2895 patients underwent 3552 EUS procedures: 3034 (85 %) upper EUS, of which 710 (23 %) included FNA, and 518 (15 %) lower EUS, of which 23 (4 %) involved FNA. Overall, 69 procedures (2 %) involved an adverse event that was either definitely or possibly related to EUS, with 33 (1 %) requiring hospitalization. None of the adverse events required intensive care or resulted in death. On multivariable analysis, only FNA was associated with increased risk of adverse events (odds ratio 6.43, 95 % confidence interval 3.92-10.55; P < 0.001). Conclusion Upper and lower EUS were generally safe but FNA substantially increased the risk of adverse events. EUS-related complications requiring hospitalization were rare.

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