• Users Online:161
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
IMAGES AND VIDEOS
Year : 2021  |  Volume : 10  |  Issue : 1  |  Page : 73-74

Delayed gastric bleeding after EUS-guided fine-needle aspiration of autoimmune pancreatitis


Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Date of Submission08-Aug-2020
Date of Acceptance20-Oct-2020
Date of Web Publication05-Jan-2021

Correspondence Address:
Dr. Hui Xu
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing
China
Dr. Yunlu Feng
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1#, Beijing
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/eus.eus_74_20

Rights and Permissions

How to cite this article:
Shi W, Zhang S, Xu H, Feng Y, Yang A. Delayed gastric bleeding after EUS-guided fine-needle aspiration of autoimmune pancreatitis. Endosc Ultrasound 2021;10:73-4

How to cite this URL:
Shi W, Zhang S, Xu H, Feng Y, Yang A. Delayed gastric bleeding after EUS-guided fine-needle aspiration of autoimmune pancreatitis. Endosc Ultrasound [serial online] 2021 [cited 2021 Apr 12];10:73-4. Available from: http://www.eusjournal.com/text.asp?2021/10/1/73/306177

Wen Shi, Shengyu Zhang
The two authors contributed equally to this work.


A 33-year-old man presented with a 1-month history of upper abdominal discomfort. Magnetic resonance imaging revealed a diffusely enlarged pancreas with uneven enhancement. IgG4 levels were elevated (24,100 mg/L, normal: 80–1400 mg/L), but platelets and coagulation tests were normal. An EUS-FNA was performed (once, ten strokes) with a 19-gauge needle (BostonScientific, Expect, 19G) [Figure 1]a and [Figure 1]b; no significant bleeding was observed [Figure 1]c]. On day 6 after EUS-FNA, the patient presented with sudden-onset hematemesis and melena together with a significant decrease in serum hemoglobin (120 g/L to 93 g/L). Upper endoscopy showed bulging of the stomach mucosa consistent with the EUS-FNA puncture site and bleeding from the center of the lesion [Figure 1]d. Titanium clips were used to close the wound, and no further bleeding occurred. Pathological findings of EUS-FNA confirmed the diagnosis of Type I autoimmune pancreatitis, and the patient was started on steroids after the bleeding stopped.
Figure 1: EUS-FNA of the patient. (a) EUS showed diffuse enlargement of the pancreas, with hypoechoic parenchyma and multiple dot-like and linear hyperechoic lesions. (b) EUS-FNA was performed (once, ten strokes) with a 19-gauge needle. (c) No significant bleeding was observed just after the procedure. (d) An emergency upper endoscopy showed mucosal swelling at the upper posterior wall of the body of the stomach consistent with the puncture site, with bleeding on day 6 after EUS-FNA

Click here to view


The incidence of bleeding due to EUS-FNA of pancreatic lesions is reported to be 0%–1%, with most hemorrhage occurring during the procedure or within 3 days.[1] Delayed bleeding is extremely rare. We performed a literature review and found three other published cases of delayed hemorrhage after EUS-FNA of pancreatic lesions [Table 1].[2],[3],[4] The time of bleeding ranged from 6 days to 3 weeks after the procedure, and the site of bleeding included intramural hematoma, retroperitoneal hemorrhage, and mucosal damage at the puncture site. Two of four patients were on anticoagulants. A 19-guage needle was used in two cases, while a 22-gauge needle was used in the other two cases. While three of four cases recovered, one patient on anticoagulants died due to uncontrolled retroperitoneal hemorrhage. To our knowledge, this is the first reported case of an autoimmune pancreatitis patient experiencing delayed bleeding after EUS-FNA. Although IgG4-related disease has been reported to cause acquired hemophilia,[5] our patient had completely normal coagulation tests and he was not on anticoagulation or antiplatelet therapy. The cause of delayed bleeding in the current case remains unknown, but possible explanations might include needle injury to one of the penetrating gastric arteries. Endoscopists must be aware of the uncommon yet possible delayed bleeding complication of EUS-FNA.
Table 1: Published cases of delayed bleeding after EUS-FNA of pancreatic lesions

Click here to view


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yoshinaga S, Itoi T, Yamao K, et al. Safety and efficacy of endoscopic ultrasound-guided fine needle aspiration for pancreatic masses: A prospective multicenter study. Dig Endosc 2020;32:114-26.  Back to cited text no. 1
    
2.
Iida T, Adachi T, Nakagaki S, et al. Hemorrhagic gastric ulcer after endoscopic ultrasound-guided fine needle aspiration of a pancreatic adenocarcinoma. Endoscopy 2015;47 Suppl 1:E635-6.  Back to cited text no. 2
    
3.
Roseira J, Cunha M, Tavares de Sousa H, et al. Delayed intramural duodenal hematoma after a simple diagnostic endoscopic ultrasonography fine-needle aspiration procedure. ACG Case Rep J 2019;6:e00279.  Back to cited text no. 3
    
4.
Sendino O, Fernández-Esparrach G, Solé M, et al. Endoscopic ultrasonography-guided brushing increases cellular diagnosis of pancreatic cysts: A prospective study. Dig Liver Dis 2010;42:877-81.  Back to cited text no. 4
    
5.
Li X, Duan W, Zhu X, et al. Immunoglobulin G4-related acquired hemophilia: A case report. Exp Ther Med 2016;12:3988-92.  Back to cited text no. 5
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed526    
    Printed13    
    Emailed0    
    PDF Downloaded57    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]