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

Table 3 Uncommon complications of endoscopic ultrasound-guided celiac plexus neurolysis

Ref.	Composition of injection solution	Complication	Treatment and outcome	Prevention recommendation
Fujii et al[47]	0.25% bupivacaine in 99% alcohol (ganglia: 1 mL; plexus: 23 mL)	Paraplegia	Remained paraplegic until death	Use color Doppler to avoid intravascular injection Minimize the volume of absolute alcohol
Mittal et al[48]	0.25% bupivacaine and epinephrine with alcohol (1:5) (ganglia: 5 mL; around the celiac artery: 19 mL)	Paraplegia	Lumbar drainage but no improvement
Jang et al[56]	0.25% bupivacaine (5 mL), 98% ethanol (10 mL), triamcinolone (1 mL)	Hepatosplenic, stomach, and small bowel infarctions, gastroduodenal ulcers	Supportive treatment, died 27 d later
Ahmed et al[57]	0.25% bupivacaine (20 mL), 98% ethanol (20 mL)	Pancreaticosplenic infarction, gastric ischemia and stenosis	Subtotal gastrectomy with Roux-en-Y gastrojejunostomy
Gimeno-García et al[58]	0.5% bupivacaine (5 mL), absolute alcohol (10 mL) on each side of the celiac takeoff	Thrombosis of celiac artery, pneumatosis of the stomach andsmall and large intestines, and liver, kidney, and spleen infarctions	Conservative treatment, died 8 d later
Muscatiello et al[59]	Not mentioned	Peripancreatic abscess	EUS-guided aspiration of abscess and ceftazidime injection	Consider antibiotic prophylaxis
Lalueza et al[60]	Not mentioned	Brain abscess by Cladosporium macrocarpum and Streptococcus constellatus	Surgery, antibiotics, and antifungal

EUS: Endoscopic ultrasound.