Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications

Table 5 Contraindications to endoscopic ultrasonography and endoscopic ultrasonography-guided fine needle biopsy

Contraindications to EUS and EUS-FNB
Lack of informed consent1
Lack of cooperation or insufficient sedation1
Results of examination are unlikely to have a significant clinical impact1
Anticoagulation treatment or non-substituted coagulopathy (international normalized ratio > 1.5; platelet count < 50 000/mL; heparin administration at therapeutic doses)2
Inhibition of platelet aggregation by clopidogrel and other thienopyridines2
Failure of ultrasonographic needle control2
EUS-FNB of lesions upstream of a bile duct stricture which is insufficiently drained2
Cystic mediastinal and pelvic lesions23
Interposition of vessels24

¹Contraindication to endoscopic ultrasonography (EUS) and endoscopic ultrasonography-guided fine needle biopsy (EUS-FNB);

²contraindication to EUS-FNB;

³relative contraindication, peri-interventional antibiotic treatment is mandatory;

⁴relative contraindication, benefit has to be weighed carefully against risk. Transaortic endoscopic ultrasonography-guided fine needle aspiration of mediastinal lymph nodes and tumors[184,185] of the pericardium and a left atrial mass[186], and of intravascular tumors[187,188] have been reported without any major complications.