Needle Tract Seeding: An Overlooked Rare Complication of Endoscopic Ultrasound-Guided Fine-Needle Aspiration

Abstract

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been widely used for diagnosis of both inflammatory and tumor lesions located in and adjacent to the gastrointestinal tract. EUS-FNA has been considered to be a safe technique with few complications, as shown in recent review articles in which EUS-FNA-related morbidity and mortality rates were reported to be <1%. It should be noted, however, that needle tract seeding, although uncommon, can occur after diagnostic EUS-FNA and that this complication affects the prognosis of patients. Although an accurate value for the frequency of needle tract seeding caused by EUS-FNA has not been reported, the numbers of case reports on needle tract seeding have been rapidly increasing, especially in Japan. These case reports regarding EUS-FNA-related needle tract seeding prompted us to reevaluate the safety of EUS-FNA because this complication may have a significant influence on patients' prognoses. In this review, we summarize the clinical features and outcomes of needle tract seeding after EUS on the basis of the previously reported cases and provide useful information to prevent and reduce this serious complication.

Value of contrast‐enhanced harmonic endoscopic ultrasonography in differentiating between gastrointestinal stromal tumors: A meta‐analysis

“…The incidence of adverse events, including bleeding, infection, and needle seeding, is 0.98%, and the total mortality rate is 0.02%. Due to these adverse events and the risk of damaging tumor integrity, some experts have expressed reservations about the use of EUS‐FNA in assessing GIST . Therefore, more effective noninvasive methods for the early diagnosis and discrimination of GIST are urgently needed.…”

“…Due to these adverse events and the risk of damaging tumor integrity, some experts have expressed reservations about the use of EUS-FNA in assessing GIST. 29,30 Therefore, more effective noninvasive methods for the early diagnosis and discrimination of GIST are urgently needed.…”

Surveillance of Individuals with a Family History of Pancreatic Cancer and Inherited Cancer Syndromes: A Strategy for Detecting Early Pancreatic Cancers

“…An ENPD test should be avoided in cases with a high risk of post-ERCP pancreatitis, such as those with rich pancreatic parenchyma, a normal MPD width, pancreatic divisum, the secretion of highly viscous mucus that may stick inside an ENPD, etc. Pre-surgical EUS-FNA from the image-typical cancer lesions at the pancreas' body and tail are controversial, because of the possibility of cancer seeding [97]. Indications for these examinations should be discussed among experts at each institution prior to their use.…”

Image-Guided Percutaneous Biopsy and Drainage of the Abdomen

“…57,58 While commonly performed, endoscopic biopsies are often limited to FNA, due to limitations in equipment size that preclude the use of cutting needles. 59 When FNA is insufficient to provide a diagnosis, imageguided percutaneous core biopsy may have a role. Few studies report of the use of image-guided percutaneous methods of gastrointestinal tract biopsy, but the limited data suggest that percutaneous gastrointestinal tract biopsy is safe, with low risk of bowel injury or infections complications.…”