Strategic International Session2(JGES・JSGE・JSGS)
Fri. November 3rd   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
ST2-Keynote Lecture
 Troubleshooting of interventional EUS and how to avoid
Hsiu-Po Wang
National Taiwan University Hospital
Endoscopic Ultrasound (EUS) has changed its role from a diagnostic tool to the therapeutic modality owing to the technological advancements. Because of interventional EUS involves several transluminal endoscopic procedures, troubleshooting occurs. The success rate of interventional EUS has been reported high, but it can not be achieved without complications which are not desired.
Interventional EUS includes EUS guided drainage - drainage of fluid collection/EUS-BD/EUS-PD, EUS-guided anastomosis - EUS-GJ/JJ, EUS guided vascular intervention, EUS guided tumor ablation and EUS-guide neurolysis. The common troubleshooting of interventional EUS includes bleeding & perforation due to steps of puncture tract dilation; pancreatitis/peripancreatic fluid formation due to pancreatic duct manipulation, bile leakage due to biliary tree manipulation - EUS-CDS/HGS/GBD. Others include stent mal-deployment/migration/late complications of stents.
Pre-procedure prophylactic antibiotics is suggested to decrease the risk of infection. There is a risk of bleeding during or after the procedures. The risk may be higher in individuals with bleeding disorders or those taking blood-thinning medications. It is essential to correct bleeding tendency and stop the medications and check the intervening vessels before puncture. To prevent perforation, selection of the proper puncture instruments and dilators is important. And operators should be familiar with the procedures of dilation and stent deployment. Other complication in EUS-GJ included aspiration of fluid which may be prevented by tracheal intubation during the procedure and hyponatremia if water infusion method which should be avoid with infusion of saline or use the balloon assistance method.
Besides, interventional EUS should be performed by experienced hands and high-volume centers.
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