Retrospective cohort study comparing endoscopic ultrasound‐guided and percutaneous drainage of upper abdominal abscesses

Abstract

Background and Aim Endoscopic ultrasonography (EUS)‐guided drainage (EUS‐D) has become the standard treatment for peripancreatic fluid collections. Its use in other intra‐abdominal abscesses has been reported, although there is limited evidence. Methods We carried out a single‐center retrospective cohort study comparing percutaneous drainage (PCD) and EUS‐D of upper abdominal abscesses between January 2012 and June 2017. Pancreatic fluid collections and liver transplant recipients were excluded. Primary endpoints were technical and clinical success rates. Results We included 18 EUS‐D (nine hepatic and nine intraperitoneal abscesses) and 62 PCD. There were no differences regarding age, gender and etiology. Size was larger in the PCD group (80 vs 65.5 mm, P = 0.04) and perivesicular location was more frequent in the PCD group (24.2% vs 11.1%, P = 0.003). In the EUS‐D group, metal stents were deployed in 16 (88.9%) subjects (eight lumen‐apposing metal stents and eight self‐expandable metal stents), coaxial double‐pigtail plastic stents in six (33.3%) and lavage/debridement was carried out in five (27.8%). There were no significant differences in technical success (EUS‐D: 88.9%, PCD: 96.8%, P = 0.22) or clinical success (EUS‐D: 88.9%, PCD: 82.3%, P = 0.50), with no relapses in the EUS‐D group and 10 (16.1%) in the PCD group (P = 0.11). There were four (22.2%) adverse events in the EUS‐D group, none of them severe, and 13 (21%) in the PCD group (P = 0.91). Conclusions EUS‐D is an alternative to PCD in the treatment of upper abdominal abscesses, reaching similar success, relapse and adverse events rates.

Endoscopic ultrasound-guided drainage of a fungal liver abscess using a lumen-apposing metal stent: case report and literature review

“…The close proximity of the liver, in particular the left hepatic lobe, to the EUS transducer in the gastric cavity stimulated endosonographers to utilize EUS for hepatic abscesses drainage. Table 1 summarizes all cases reported so far, which were all retrospectively described [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Different techniques, such as EUS-guided insertion of naso-abscess drains, plastic stents, fully or partially covered self-expandable metal stents (SEMS), or LAMS have been utilized.…”

“…Overall, 40 patients have been treated, mostly with abscesses in the left/caudate liver lobes (31/40, 77.5%), with both a technical and clinical success rate of 95%. Adverse events were reported in two patients, with one case of fully covered SEMS dislodgment during lavage [23] and another one of intra-abscess SEMS migration, which was discovered few days after placement that was re-cannulated with a guidewire followed by successfully double pig-tail plastic stent insertion with clinical resolution [15].…”

“…In two studies a comparison between EUS and percutaneous liver abscess drainage was made [19,23]. In the first one, eight patients who underwent EUS-guided drainage using tubular SEMS due to contraindication of the percutaneous route, were compared with 19 patients treated with percutaneous drainage [19].…”

“…Both showed clinical resolution rate of 78.2%. Unfortunately, no additional data could be obtained from the paper because liver abscesses were mixed with other upper abdominal collections [23].…”

Endoscopic ultrasound-guided transgastric drainage of radiologically inaccessible left lobe liver abscess involving segment 4, caudate lobe, and left lateral segments using a modified technique

“…Double pigtail stents 7F to 10F and/or 5F to 7F NCD were used as endoprostheses in the early reported cases [1][2][3][4][5][6]9]. In all recent publications, the authors have favored fully-covered self-expandable metal stent (FCSEMS) over plastic stents to achieve complete drainage and early abscess resolution [7][8]10]. The poblem with plastic stents is inadequate drainage.…”