Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications

Figure 1 Flexibility and rigid tip of echoendoscopes and standard videoendoscopes. A: Longitudinal video-echoendoscope EG-3870 UTK (left; Pentax Medical/Hitachi Medical Systems; angulation up/down 130/130 degrees) with an approximately 50-mm long rigid tip at the distal end (diameter 12.8 mm). The therapeutic video-duodenoscope ED-3490 TK from the same manufacturer (right; Pentax Medical; distal outer diameter 11.6 mm, angulation up/down 120/90 degrees); B: Radial video-echoendoscope EG-3670 URK (left; Pentax Medical/ Hitachi Medical Systems; angulation up/down 130/60 degrees) with an approximately 50-mm long rigid tip at the distal end (diameter 12.1 mm) and the standard video-gastroscope EG-2990i from the same manufacturer (right: Pentax Medical; distal outer diameter 9.8 mm, angulation up/down 210/120 degrees).

Figure 3 Extraluminal bleeding from needle track following endoscopic ultrasonography-guided fine-needle aspiration. Hemorrhage occurred immediately after endoscopic ultrasonography-guided fine-needle aspiration (22 Gauge) of a splenic metastasis (M) of gastric cancer. A: Note blood flow within needle track (arrows), which extends beyond the splenic capsule (arrowhead); B: Bleeding ceased spontaneously approximately 3 min later (no detectable flow within the needle track; arrows).

Figure 2 Intraluminal bleeding after endoscopic ultrasonography-guided fine-needle aspiration. Marked intraluminal bleeding occurred following 19 G endoscopic ultrasonography-guided fine-needle aspiration of a large, hypervascularized gastrointestinal stromal tumor in the stomach. Hemorrhage stopped without intervention.