Effectiveness of EUS in drainage of pelvic abscesses in 25 consecutive patients (with video)

doi:10.1016/j.gie.2009.08.034

Gastrointestinal Endoscopy

Volume 70, Issue 6, December 2009, Pages 1121-1127

https://doi.org/10.1016/j.gie.2009.08.034 Get rights and content

Background

Preliminary evidence suggests that EUS is a minimally invasive alternative to surgery and percutaneous techniques for drainage of pelvic abscesses. The EUS 2008 Working Group identified the technique as a priority for research and recommended its validation in a larger cohort of patients.

Objective

To evaluate the rates of technical and treatment success, rate of recurrence, and complications of EUS-guided drainage of a pelvic abscess in a large cohort of patients.

Study design

Observational study.

Setting

Academic tertiary referral center.

Patients

Consecutive patients referred for EUS-guided drainage of a pelvic abscess that was not amenable to drainage under US or CT guidance.

Methods

In patients with an abscess that measured less than 8 cm in size, two 7F transrectal stents were deployed. In patients with an abscess that measured 8 cm or more in size, an additional 10F drainage catheter was deployed. All patients underwent follow-up CT at 36 hours to assess response to therapy. If the abscess had decreased in size by more than 50%, the drainage catheters were discontinued and patients were discharged from the hospital. The stents were then retrieved by sigmoidoscopy at 2 weeks.

Main Outcome Measurements

We evaluated the rates of technical and treatment success, rate of recurrence, and complications of the EUS-based approach. Technical success was defined as the ability to drain the abscess under EUS guidance. Treatment success was defined as symptom relief in association with complete resolution of the abscess on follow-up CT at 2 weeks. Recurrence was defined as the need for repeat EUS-guided drainage of a pelvic abscess within 90 days after the stent retrieval.

Results

The procedure was technically successful in all 25 patients (100%) in whom it was attempted, and no complications were encountered. Mean size of the abscess was 68.5 × 52.4 mm. In addition to transrectal stents, a drainage catheter was deployed in 10 patients. Treatment was successful in 24 (96%) of 25 patients. The mean duration of the postprocedure hospital stay was 3.2 days. At a mean follow-up of 189 days (range 93-817), all 24 patients were doing well without abscess recurrence.

Conclusions

EUS is a minimally invasive, safe, and effective technique that affords long-term benefit for patients undergoing pelvic abscess drainage.

Section snippets

Materials and methods

This study was executed by analyzing data that were collected prospectively for all patients who underwent EUS-guided drainage of pelvic abscesses over a 28-month period between January 2007 and April 2009. The institutional review board–approved interventional EUS database comprises 64 variables that includes all demographic and clinical information of patients, technical data, and clinical outcomes of patients with long-term follow-up. All patients were referred by GI surgeons or

Results

Thirty patients were referred for EUS-guided drainage of a pelvic abscess. Clinical presentation included abdominal pain in all 30 patients and fever in 19. Five patients were excluded from the study because the abscess was perianal in location in 2, the walls were immature in 1, an alternative diagnosis of perirectal cyst was established by EUS in 1, and the pelvic fluid collection was diagnosed as an anastomotic dehiscence in 1. The procedure was technically successful in all the 25 (100%)

Discussion

In this study, the largest reported to date on EUS-guided drainage of a pelvic abscess, the technique was found to be safe and highly effective, yielding long-term clinical benefit to most patients. Anastomotic leak after colorectal resection is the most common surgical cause for pelvic abscess formation.1, 2, 3 Despite establishing adequate blood supply and ensuring a tension-free anastomosis, leaks develop in 0.5% to 6% of patients. No major difference in outcomes has been reported between

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Overall, 100% of procedures were successful. Clinical success was achieved in 11 patients and they were discharged after EUS-PAD within 21.4 days on an average and the average duration of stent placement before removal was 27.0 days. Of all, six patients achieved complete improvement status where the cause was appendiceal perforation while two and one of the patients were recovered where the causes were post-curative operation for carcinoma and walled-off necrosis, respectively. Eight out of eleven patients who exhibited appendiceal perforation or underwent radical rectal cancer surgery were discharged after an average of 9.4 days post EUS-PAD. Although two patients showed temporary improvement, with perianal abscess and controlled rectal carcinoma, the PA worsened as the primary disease intensified. The PA drainage was ineffective in three patients where two of them had uncontrolled rectal cancer and one had diverticular perforation.
Conclusively, the EUS-PAD is not only a reliable, safe, and efficient alternative to surgical and percutaneous drainage but also a valuable procedure with a high success rate for patients with acute infections, such as those who have had an appendiceal perforation or curative surgery. Poor indications and contraindications for EUS-PAD include uncontrolled gastrointestinal perforation and direct tumor invasion.
Endoscopic ultrasound in CRC
2021, Foundations of Colorectal Cancer
Endoscopic ultrasonography or EUS is a technique that arises as an evolution of conventional endoscopy. It allows a clear study of the structure of the rectal wall and surrounding tissues, so that it plays a fundamental role in preoperative TN staging of rectal adenocarcinoma, delimiting the degree of tumor invasion of the wall and the presence of pathological adenopathies. The increasing use has given it an interventional role through three possibilities: (1) Insert needles to obtain pathological material in what is known as EUS-FNA either in the case of early tumors with doubtfully pathological adenopathies to be more precise in staging, or else in the case of adenopathic tumor recurrence accessible from the digestive tract. (2) The possibility of internally draining collections, that is, into the digestive system itself through the insertion of transmural prostheses, those collections of postoperative causes that are fundamentally infectious or as a result of dehiscence of the anastomoses derived from rectal tumor resection surgery. (3) The possibility of extrahepatic bile duct drainage in cases of bile duct obstruction secondary to adenopathic recurrence in the hepatic hilum, which cannot be corrected by endoscopic retrograde cholangiopancreatography or ERCP.
EUS-guided drainage of postsurgical fluid collections using lumen-apposing metal stents: a multicenter study
2018, Gastrointestinal Endoscopy
Postsurgical fluid collections (PSFCs) are traditionally drained either percutaneously or surgically. Endoscopic drainage offers several advantages compared with either percutaneous or surgical approaches, including avoiding repeat surgery or the need to have a percutaneous drain in place for weeks. There are very little data regarding the use of lumen-apposing metal stents (LAMSs) in the drainage of PSFCs. We aim to study the technical and clinical success and adverse events (AEs) of using LAMSs in the drainage of PSFCs.
Collaborators from 8 centers retrospectively reviewed their endoscopic databases to find procedures using LAMSs for drainage of PSFCs. Technical success (successful placement of LAMSs into the fluid collection), clinical success (complete resolution of the fluid collection on repeat imaging or endoscopy), and intraprocedure and postprocedure AEs were measured.
Forty-seven patients were identified with PSFCs after various surgeries. Thirteen patients had failed previous percutaneous or surgical drainage attempts. Fluid collections averaged 78.6 mm (range, 47-150 mm) in size. The most common site of stent placement was transgastric, followed by rectum and duodenum. Technical success rate was 93.6% and clinical success rate 89.3%. The intraprocedural AE rate was 4.25% and postprocedural AE rate 6.4%. There was 1 death unrelated to the procedure.
The use of LAMSs to drain PSFCs has a high technical and clinical success rate with low AEs. For collections that are favorably located adjacent to the stomach, duodenum, or rectum, LAMS placement is a viable alternative to repeat surgery or percutaneous drainage.
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Citation Excerpt :
Plastic stents have been used for EUS guided pelvic abscess drainage. It is important to note that spontaneous migration of plastic stents and multiple stent placements were frequently observed in previous studies [9,10]. Using fully covered metal stent was recently postulated as a potential solution to avoid the complications associated with plastic stents.

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Original articleClinical endoscopyEffectiveness of EUS in drainage of pelvic abscesses in 25 consecutive patients (with video)

Background

Objective

Study design

Setting

Patients

Methods

Main Outcome Measurements

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Anastomotic integrity after operations for large bowel cancer: a multicentre study

BMJ

A multivariate analysis of factors contributing to leakage of intestinal anastomoses

J Am Coll Surg

Original article
Clinical endoscopy
Effectiveness of EUS in drainage of pelvic abscesses in 25 consecutive patients (with video)