Uncommon complications of therapeutic endoscopic ultrasonography: What, why, and how to prevent

Table 2 Uncommon complications of endoscopic ultrasound-guided pancreatic drainage

Ref.	Procedure	Stent	Complication (n/total successful cases)	Postulated causes	Treatment	Prevention recommendation
Hikishi et al[41]	EUS-cystogastrostomy drainage	Plastic stent, nasobiliary drainage	Gallbladder puncture and drainage	Marked distension of gallbladder with debris, overlapping location between pseudocyst and gallbladder in fluoroscopy	Conservative with antibiotics	EUS scanning prior to initiating drainage intervention
Barkay et al[29]	EUS-PD rendezvous, dye injection	Plastic stent	Peripancreatic abscess (1/10), wire shearing (1/10)	Failed to inject PD (peripancreatic abscess), repeated to-and-fro movements of wire	Percutaneous drainage (abscess), transluminal removal (wire)	Carefully manipulate the guidewire, avoid acute angles
Jow et al[40]	EUS-cystogastrostomy drainage	Not mentioned	Air emboli	Prolonged high pressure air sufflation, inflammation, mechanical injury	(Dead)	Use CO2 inflation instead of air
Fujii et al[36]	EUS-PD stent (antegrade and retrograde)	Plastic stents	Peripancreatic abscess (1/32), wire shearing (1/32)	Balloon dilation? Multiple devices (peripancreatic abscess), injury from EUS needle (wire shearing)	EUS-guided transmural drainage (abscess)	Carefully manipulate the guidewire
Kurihara et al[38]	EUS-PD rendezvous, and PD stenting	Plastic stents, UCSEMS	Pancreatic pseudocyst with splenic artery aneurysm	Pancreatic juice leakage	Angiographic embolization	Avoid major vascular structures

EUS-PD: Endoscopic ultrasound-guided pancreatic duct drainage; PD: Pancreatic duct; UCSEMS: Uncovered self-expandable metallic stent.