Incidence of Bleeding in 8172 Percutaneous Ultrasound-Guided Intraabdominal Diagnostic and Therapeutic Interventions - Results of the Prospective Multicenter DEGUM Interventional Ultrasound Study (PIUS Study)

被引：50

作者：

Strobel, D. ^{[1
]}

Bernatik, T. ^{[2
]}

Blank, W. ^{[3
]}

Will, U. ^{[4
]}

Reichel, A. ^{[4
]}

Wuestner, M. ^{[5
]}

Keim, V. ^{[6
]}

Schacherer, D. ^{[7
]}

Barreiros, A. P. ^{[8
]}

Kunze, G. ^{[9
]}

Nuernberg, D. ^{[10
]}

Ignee, A. ^{[11
]}

Burmester, E. ^{[12
]}

Bunk, A. A. ^{[13
]}

Friedrich-Rust, M. ^{[14
]}

Froehlich, E. ^{[15
]}

Schuler, A. ^{[16
]}

Jenssen, C. ^{[17
]}

Bohle, W. ^{[18
]}

Mauch, M. ^{[19
]}

Dirks, K. ^{[20
]}

Kaemmer, J. ^{[21
]}

Pachmann, C. ^{[22
]}

Stock, J. ^{[23
]}

Hocke, M. ^{[24
]}

Kendel, A. ^{[25
]}

Schmidt, C. ^{[26
]}

Jakobeit, C. ^{[27
]}

Kinkel, H. ^{[28
]}

Heinz, W. ^{[29
]}

Huebner, G. ^{[30
]}

Pichler, M. ^{[31
]}

Mueller, T. ^{[3
]}

机构：

[1] Univ Hosp Erlangen, Internal Med 1, Erlangen, Germany

[2] Dist Hosp Ebersberg, Dept Internal Med, Ebersberg, Germany

[3] Municipal Hosp Steinenberg, Dept Internal Med 1, Reutlingen, Germany

[4] Waldklinikum Gera gGmbH, Municipal Hosp, Dept Gastroenterol, Gera, Germany

[5] Municipal Hosp Trier Barmherzige Bruder, Cent Interdisciplinary Ultrasound, Trier, Germany

[6] Univ Hosp Leipzig, Dept Gastroenterol, Cent Ultrasound Unit, Leipzig, Germany

[7] Univ Hosp Regensburg, Dept Internal Med 1, Regensburg, Germany

[8] Univ Hosp Mainz, Dept Internal Med 1, Mainz, Germany

[9] Municipal Hosp Schwarzwald Baar, Dept Internal Med 1, Villingen Schwenningen, Germany

[10] Ruppiner Kliniken, Dist Hosp, Gastroenterol, Dept Internal Med B, Neuruppin, Germany

[11] Municipal Hosp Caritas, Dept Internal Med 2, Bad Mergentheim, Germany

[12] Sana Kliniken Lubeck GmbH, Municipal Hosp, Dept Internal Med Gastroenterol, Lubeck, Germany

[13] Univ Hosp Dresden, Surg, Dresden, Germany

[14] Univ Hosp Frankfurt, Dept Internal Med 1, Frankfurt, Germany

[15] Karl Olga Krankenhaus, Municipal Hosp, Dept Internal Med 1, Stuttgart, Germany

[16] Dist Hosp Helfenstein, Dept Internal Med, Geislingen, Germany

[17] Krankenhaus Markisch Oderland GmbH, Dist Hosp, Dept Internal Med, Wriezen, Germany

[18] Municipal Hosp Katharinen, Dept Med & Gastroenterol, Stuttgart, Germany

[19] SRH Kliniken Sigmaringen, Dist Hosp, Innere Med, Sigmaringen, Germany

[20] Dist Hosp Rems Murr, Dept Interal Med & Gastroenterol, Winnenden, Germany

[21] Hosp St Hedwig, Depatment Internal Med, Berlin, Germany

[22] Israeli Hosp, Dept Internal Med, Hamburg, Germany

[23] Hosp Vivantes Humboldt, Gastroenterol, Berlin, Germany

[24] Dist Hosp Helios, Dept Med & Gastroenterol 2, Meiningen, Germany

[25] Dist Hosp Gummersbach, Dept InternalMedicine, Gummersbach, Germany

[26] Hosp Albertinen, Dept Internal Med, Hamburg, Germany

[27] St Josefs Hosp Helios, Gastroenterol, Bochum, Germany

[28] Municipal Hosital Duren, Dept Internal Med 2, Duren, Germany

[29] Hosp Leonberg, Dept Internal Med, Leonberg, Germany

[30] Dist Hosp Kothen, Dept Internal Med, Kothen, Germany

[31] Univ Hosp Munich, Munich, Germany

来源：

ULTRASCHALL IN DER MEDIZIN | 2015年 / 36卷 / 02期

关键词：

abdomen; biopsy; interventional procedures; percutaneous; ultrasound; FINE-NEEDLE-BIOPSY; ASPIRATION BIOPSY; LIVER-BIOPSY; MAJOR COMPLICATIONS; AUDIT; ULTRASONOGRAPHY; EXPERIENCE; EFFICACY; SAFETY; RISK;

D O I：

10.1055/s-0034-1399282

中图分类号：

O42 [声学];

学科分类号：

070206 ; 082403 ;

摘要：

Purpose: To analyse the incidence of bleeding after percutaneous ultrasound guided diagnostic and therapeutic intraabdominal interventions in a prospective multicentre study (DEGUM percutaneous interventional ultrasound study). Materials and Methods: Within a time period of 2 years diagnostic and therapeutic intraabdominal interventions (with the exclusion of ascites paracentesis) performed percutaneously under continuous ultrasound (US) guidance were prospectively assessed using a pseudonymized standardized web site entry form. Number and type of intervention, operator experience, patient characteristics, medication, lab data as well as technical aspects of the procedure and bleeding complications were analysed according to the interventional radiology standards. Results: 8172 US-guided intraabdominal interventions (liver n = 5903; pancreas n = 501, kidney n = 434, lymph node = 272, biliary system n = 153, spleen n = 63, other abdominal organs and extraorganic targets n = 999) were analysed in 30 hospitals. The majority were diagnostic biopsies including 1780 liver parenchyma, 3400 focal liver lesions and 404 pancreatic lesions. 7525 interventions (92.1 %) were performed in hospitalized patients (mean age 62.6 years). Most operators were highly experienced in US-guided interventions (>500 interventions prior to the study n = 5729; 70.1 %). Sedation was administered in 1131 patients (13.8 %). Needle diameter was >= 1 mm in 7162 punctures (87.9 %) with main focus on core needle biopsies (18 G, n = 4185). Clinically relevant bleeding complications with need of transfusion (0.4 %), surgical bleeding control (0.1 %) and radiological coiling (0.05 %) were very rare. Bleeding complications with fatal outcome occurred in four patients (0.05 %). The frequency of major bleeding complications was significantly higher in patients with an INR > 1.5 (p < 0.001) and patients taking a medication potentially interfering with platelet function or plasmatic coagulation (p < 0.0333). Conclusion: This prospective multicentre study confirms the broad spectrum of percutaneous US-guided intraabdominal interventions. However diagnostic liver biopsies dominate with the use of core needle biopsies (18 G). Percutaneous US-guided interventions performed by experienced sonographers are associated with a low bleeding risk. Major bleeding complications are very rare. A pre-interventional INR < 1.5 and individual medication risk assessment are recommended.

引用

页码：122 / 131

页数：10

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