Department of Internal Medicine, Brown University, Rhode Island Hospital, Jane Brown Ground, 593 Eddy StreetSuite 0100, Providence, RI, USA.
Division of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, USA.
Dig Dis Sci. 2022 Jun;67(6):2074-2080. doi: 10.1007/s10620-021-07050-x. Epub 2021 May 20.
New innovations and increasing utility of endoscopic ultrasound (EUS) are associated with rare but serious risks. We investigate the rates and risk factors for post-procedural complications over a four-year period at a new advanced endoscopy program.
We conducted a retrospective review of all adult patients who underwent upper EUS at an academic level-1 trauma center between April 2015 and November 2019. The primary outcome was the incidence of adverse events within 1 week of EUS. Secondary outcomes included emergency department visits and mortality within 30 days after EUS. Chi-square test, t test, and multivariable logistic regression were used to assess risk factors for post-procedural complications.
A total of 968 EUS procedures were performed on 864 patients (54% female; 79% Caucasian; mean age 61 years). The overall incidence of post-procedural adverse event with EUS was 5.6%. The probability of an adverse event decreased by an average of 22% per year (p =0.01, OR 0.78). The risk for adverse events were 3.3% acute pancreatitis, 1.9% clinically significant bleeding, 0.3% bacteremia, 0.2% perforation, and 2.4% 30-day mortality. The adverse event rate was highest among low volume proceduralists (p =0.04). The 30-day mortality was more than threefolds among patients who had an adverse event within 7 days after EUS.
The overall incidence of post-procedural adverse events at a new EUS program was 5.6%, with an average of 22% relative decrease in adverse events per year in the first 4 years.
新的创新和内镜超声（EUS）的使用增加与罕见但严重的风险相关。我们调查了在一个新的高级内镜计划中，四年期间内镜检查后并发症的发生率和危险因素。
我们对 2015 年 4 月至 2019 年 11 月期间在一家学术一级创伤中心接受上消化道 EUS 的所有成年患者进行了回顾性分析。主要结局是 EUS 后 1 周内不良事件的发生率。次要结局包括 EUS 后 30 天内的急诊就诊和死亡率。使用卡方检验、t 检验和多变量逻辑回归评估术后并发症的危险因素。
共对 864 例患者进行了 968 例 EUS 检查（54%为女性；79%为白人；平均年龄为 61 岁）。EUS 术后不良事件的总发生率为 5.6%。EUS 后不良事件的概率平均每年降低 22%（p =0.01，OR 0.78）。不良事件的风险为急性胰腺炎 3.3%，临床显著出血 1.9%，菌血症 0.3%，穿孔 0.2%，30 天死亡率 2.4%。低容量操作医生的不良事件发生率最高（p =0.04）。EUS 后 7 天内发生不良事件的患者 30 天死亡率是其他患者的三倍多。
新 EUS 计划的术后不良事件总发生率为 5.6%，前 4 年每年不良事件相对减少 22%。
