ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2019 and some content may be unavailable. To unlock all content for 2019, please visit the archives.

Abstract: SA-PO964

Using Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) on Pancreatic Lesions in Peritoneal Dialysis (PD) Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Lew, Susie Q., George Washington University Medical Center, Washington, District of Columbia, United States
  • Khan, Ali Asif, George Washington University, Washington, District of Columbia, United States
  • Rieders, Brandon, George Washington University Hospital, Washington, District of Columbia, United States
  • Agrawal, Satyanisth T., George Washington University, Washington, District of Columbia, United States
Introduction

Any invasive procedure involving the abdominal or pelvic regions in a PD patient raises concerns for infection, bleeding, and peritoneal fluid leakage. EUS-FNA is a well-established minimally invasive GI procedure to diagnose and stage cancers of the pancreas, upper GI tract, and mediastinum.
We report the pre-procedure preparation, peri-procedure precautions, and outcomes of 2 PD patients who underwent EUS-FNA for suspicious pancreatic lesions. These cases are the first to be reported in the literature.

Case Description


Patients performed the following to avoid complications and ensure the best outcome:
1-Performed additional dialysis daily for 3 days pre-procedure to optimize volume, electrolyte, and acid-base status as well as remove uremic toxins to improve platelet function.
2-Stopped any medications that would interfere with coagulation.
3-Reported to EUS-FNA with minimal PD fluid and received IV prophylactic antibiotics (ampicillin 1 gm and gentamicin 1 mg/kg) within 1 hr pre-procedure to minimize peritonitis risk.
4-Delayed restarting PD for 48 hrs to reduce peritonitis, bleeding and PD fluid leakage risks.
5-Monitored for abdominal pain, low blood pressure, fever, and GI symptoms such as nausea, vomiting, or diarrhea.

During the EUS-FNA procedure, an endoscope with high frequency ultrasound capability examined the entire pancreas and the cystic lesion in the pancreas was sampled using a 22-gauge FNA needle. Samples were sent for pathologic evaluation. Patient-1’s findings were consistent with pancreatic pseudocyst. Patient-2’s findings were consistent with mucinous cyst, either side-branch intraductal papillary mucinous neoplasm or mucinous cystic neoplasm.
PD risks (peritonitis and PD fluid leakage) and EUS-FNA risks (perforation, infection, iatrogenic pancreatitis, bile peritonitis, fistulization, and malignancy seeding) were not appreciated. Patient-2 noted bloody PD fluid on a manual exchange without hemodynamic compromise. PD fluid cleared after another rapid exchange.

Discussion

Take away lessons:
EUS-FNA can be performed safely in PD patients with minimal short term complications.
Appropriate measure should be taken to ensure peritonitis, bleeding, and PD fluid leakage risks are minimized (see points 1-5 above)
EUS-FNA can be used to evaluate pancreatic lesions and malignancies for diagnosis and staging.