Nickl N J, Bhutani M S, Catalano M, Hoffman B, Hawes R, Chak A, Roubein L D, Kimmey M, Johnson M, Affronti J, Canto M, Sivak M, Boyce H W, Lightdale C J, Stevens P, Schmitt C
Department of Medicine, University of Kentucky Medical Center, Lexington, USA.
Gastrointest Endosc. 1996 Oct;44(4):371-7. doi: 10.1016/s0016-5107(96)70083-4.
Despite increased clinical use of endoscopic ultrasound (EUS), there are little data regarding complications of EUS or its impact on patient management.
A prospective multicenter study was completed to evaluate clinical outcomes of EUS. Before each EUS examination the endosonographer recorded further theoretical patient management plans as if EUS was unavailable. After the EUS, endosonographers recorded actual management plans based on EUS results. The actual management plan after EUS was compared to the theoretical management before EUS. Complications were assessed in short-term follow-up.
Four hundred twenty-eight subjects were enrolled. Of subjects able to be evaluated, EUS changed the treatment plan in 74%. Management changes of major importance occurred in 120 patients (31% of subjects able to be evaluated) and included decisions regarding surgery (62 patients), decisions regarding nonsurgical invasive management (36 patients), and decisions regarding further follow-up (22 patients). When there was a change in management, the change was to less costly, risky, or invasive management in 55%, to more costly/risky/invasive in 37%, and to equally costly/risky/invasive in 8%. Short-term follow-up was completed in 81% of subjects, with six complications identified (1.7%). Three complications were mild, two were moderate, one severe, and none fatal.
(1) Changes in management plan may occur in the majority of patients based on EUS results. (2) The management changes are often of major importance with regard to health care costs and safety, and are more often in the direction of less costly, risky, and invasive management. (3) EUS is safe in experienced hands.
尽管内镜超声（EUS）在临床上的应用日益增多，但关于EUS并发症及其对患者管理影响的数据却很少。
完成了一项前瞻性多中心研究以评估EUS的临床结果。在每次EUS检查前，内镜超声检查医师记录了如果没有EUS时进一步的理论患者管理计划。EUS检查后，内镜超声检查医师根据EUS结果记录实际管理计划。将EUS后的实际管理计划与EUS前的理论管理计划进行比较。在短期随访中评估并发症。
共纳入428名受试者。在能够进行评估的受试者中，EUS改变了74%的治疗计划。120名患者（占能够进行评估的受试者的31%）发生了重大管理变化，包括关于手术的决策（62例患者）、关于非手术侵入性管理的决策（36例患者）以及关于进一步随访的决策（22例患者）。当管理发生变化时，55%的变化是转向成本更低、风险更小或侵入性更小的管理，37%是转向成本更高/风险更大/侵入性更大的管理，8%是转向成本/风险/侵入性相当的管理。81%的受试者完成了短期随访，发现6例并发症（1.7%）。3例并发症为轻度，2例为中度，1例为重度，无致命并发症。
（1）基于EUS结果，大多数患者的管理计划可能会发生变化。（2）管理变化在医疗成本和安全性方面通常具有重要意义，并且更常朝着成本更低、风险更小和侵入性更小的管理方向发展。（3）在经验丰富的医生手中，EUS是安全的。
