Shyam Varadarajulu1, Ernesto R Drelichman. 1. Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA. svaradarajulu@yahoo.com
Abstract
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 x 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.
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 x 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.
Authors: B C Martins; Carlos Frederico Sparapan Marques; Caio Sérgio Rizkallah Nahas; Fábio Yuji Hondo; Wilson Pollara; Sérgio Carlos Nahas; U Ribeiro Junior; Ivan Cecconello; Fauze Maluf-Filho Journal: Surg Endosc Date: 2012-03-10 Impact factor: 4.584