International consensus addresses bleeding prevention and management in interventional ultrasound

An international expert consensus statement published in BMC Medicine provides recommendations for preventing and managing bleeding complications associated with ultrasound-guided biopsy, drainage, sclerotherapy and ablation. A multidisciplinary panel of 51 specialists from six countries developed the statement using the World Health Organization guideline development framework. Evidence quality was assessed with GRADE, and recommendations were refined through a two-round modified Delphi process.

The panel finalized 20 recommendations covering bleeding classification, risk assessment, periprocedural prevention, post-procedural monitoring and stepwise management. A proposed dual classification categorizes bleeding by onset and severity. Pre-procedural assessment incorporates procedural risk, patient factors, lesion characteristics, device-related factors and operator experience. The statement also addresses individualized periprocedural management and risk-adapted ultrasound surveillance after procedures.

Hemostatic management ranges from local compression and tract embolization to selected ultrasound-guided interventions, transarterial embolization and surgery. The framework allows application according to patient and procedural characteristics, operator experience and institutional resources. However, evidence is heterogeneous across procedures, and some recommendations depend partly on expert opinion where high-quality direct evidence is lacking. Multicenter prospective studies are needed to validate and refine the recommendations; the statement does not establish that implementing them improves clinical outcomes.