Blutungskomplikationen bei 8172 sonografisch gesteuerten diagnostischen und therapeutischen intraabdominellen Punktionen - Ergebnisse der prospektiven DEGUM Interventionsstudie (PIUS-Studie)

Purpose: To analyse the incidence of bleeding after percutaneous ultrasound guided diagnostic and therapeutic intraabdominal interventions in a prospective multicentre study (DEGUM percu- taneous interventional ultrasound study). Materials and Methods: Within a time period of 2 years diagnostic and therapeutic intraabdominal interventions (with the exclusion of ascites para- centesis) performed percutaneously under contin- uous ultrasound (US) guidance were prospectively assessed using a pseudonymized standardized web site entry form. Number and type of intervention, operator experience, patient characteristics, medi- cation, lab data as well as technical aspects of the procedure and bleeding complications were ana- lysed according to the interventional radiology standards. Results: 8172 US-guided intraabdominal inter- ventions (liver n=5903; pancreas n=501, kidney n=434, lymph node=272, biliary system n=153, spleen n=63, other abdominal organs and extra- organic targets n=999) were analysed in 30 hos- pitals. The majority were diagnostic biopsies in- cluding 1780 liver parenchyma, 3400 focal liver lesions and 404 pancreatic lesions. 7525 inter- ventions (92.1%) were performed in hospitalized patients (mean age 62.6 years). Most operators were highly experienced in US-guided interven- tions (>500 interventions prior to the study n=5729; 70.1%). Sedation was administered in 1131 patients (13.8%). Needle diameter was ≥1mm in 7162 punctures (87.9%) with main fo- cus on core needle biopsies (18 G, n=4185). Clini- cally relevant bleeding complications with need of transfusion (0.4%), surgical bleeding control (0.1%) and radiological coiling (0.05%) were very rare. Bleeding complications with fatal outcome occurred in four patients (0.05%). The frequency of major bleeding complications was significantly higher in patients with an INR >1.5 (p<0.001) Zusammenfassung !