CLINICAL IMPLICATIONS OF ENDOSCOPIC ULTRASOUND - THE AMERICAN-ENDOSONOGRAPHY-CLUB STUDY

Background: Despite increased clinical use of endoscopic ultrasound (E US), there are little data regarding complications of EUS or its impac t on patient management. Methods: A prospective multicenter study was completed to evaluate clinical outcomes of EUS. Before each EUS examin ation the endosonographer recorded further theoretical patient managem ent plans as if EUS was unavailable. After the EUS, endosonographers r ecorded actual management plans based on EUS results. The actual manag ement plan after EUS was compared to the theoretical management before EUS. Complications were assessed in short-term follow-up. Results: Fo ur hundred twenty-eight subjects were enrolled. Of subjects able to be evaluated, EUS changed the treatment plan in 74%. Management changes of major importance occurred in 120 patients (31% of subjects able to be evaluated) and included decisions regarding surgery (62 patients), decisions regarding nonsurgical invasive management (36 patients), and decisions regarding further follow-up (22 patients). When there was a change in management, the change was to less costly, risky, or invasi ve management in 55%, to more costly/risky/invasive in 37%, and to equ ally costly/risky/invasive in 8%. Short-term follow-up was completed i n 81% of subjects, with six complications identified (1.7%). Three com plications were mild, two were moderate, one severe, and none fatal. C onclusions: (1) Changes in management plan may occur in the majority o f patients based on EUS results. (2) The management changes are often of major importance with regard to health care costs and safety, and a re more often in the direction of less costly, risky, and invasive man agement. (3) EUS is safe in experienced hands.