Complication Rate of Endosonography (Endobronchial and Endoscopic Ultrasound): A Systematic Review

Abstract

Background: Endosonography [endoscopic ultrasound (EUS)-guided fine needle aspiration and endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration] is increasingly used for lung cancer staging and the assessment of sarcoidosis. Serious adverse events (SAE) have been reported in case reports, but the true incidence of complications is yet unknown. Objectives: To assess the rate of SAE related to endosonography and to investigate associated risk factors. Materials and Methods: PubMed, EMBASE and Cochrane libraries were searched for eligible references up to April 2012 and these included studies reporting on linear EUS or EBUS for the analysis of mediastinal/hilar nodal or central intrapulmonary lesions. Case series describing complications were excluded. Reported complications were classified into SAE or minor adverse events (AE). Results: 190 studies met the inclusion criteria. Information on follow-up was missing in half of the studies. In 16,181 patients, 23 SAE (0.14%) and 35 AE (0.22%) were reported. No mortality was observed. SAE were more frequent in patients investigated with EUS (0.30%) than in those investigated with EBUS (0.05%). Infectious SAE were most prevalent (0.07%) and predominantly occurred in patients with cystic lesions and sarcoidosis. In lung cancer patients, complications were rare. Discussion: Endosonography for intrathoracic nodal assessment seems safe for lung cancer patients and mortality has not been reported. For cystic lesions and sarcoidosis, there may be a small, but nonnegligible risk of infectious complications. The true incidence of SAE might be higher as accurate documentation of complications is missing in most studies.

Complications of Convex-Probe Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Multi-Center Retrospective Study

“…To the best of our knowledge, there are 2 systematic reviews and 2 Japanese survey studies in the literature describing the serious complications associated with EBUS-TBNA. 2,4,12,14 The serious complication rate of EBUS-TBNA was determined to be 0.16% in the present study.…”

“…The serious complication rate of endoscopic ultrasonography and convex-probe EBUS-TBNA was reported as 0.14% in the systematic review of von Bartheld et al 14 They reported 5 serious adverse events, consisting of 2 infectious complications, 2 pneumothorax, and 1 airway edema and hypoxemia, in 9,119 EBUS-performed cases (0.05%). There is no mortality reported either in this review or in our study.…”

“…[5][6][7][8][9]12,14 The incidences of complications may vary depending on several factors. First, follow-up of patients to detect possible complications is not often a routine procedure, and lack of documentation is also an important factor, especially for minor complications.…”

“…These reports have raised a debate on the safety of endosonography. 14 The complication rates were very low in the initial studies. However, these studies included EBUS-TBNAs performed by expert bronchoscopists, and study populations were relatively small for a reliable analysis of complications.…”

Ultrasonografía bronquial con aspiración por aguja fina en el estudio lesiones adyacentes a la vía aérea central

“…En nuestra serie no reportamos complicaciones asociadas al procedimiento. Dentro de las complicaciones reportadas en la literatura se describe el sangrado auto limitado el más frecuente, con tasas reportadas menores a 5% de los procedimientos mientras que la tasa de neumotó-rax es de 1% y sin presentar eventos fatales, similar a lo encontrado en nuestra serie 14,15 .…”