Safety and clinical efficacy of EUS-guided pelvic abscess drainage

Maher Al Khaldi; Alexander Ponomarev; Carole Richard; François Dagbert; Herawaty Sebajang; Frank Schwenter; Ramses Wassef; Éric De Broux; Richard Ratelle; Sarto C Paquin; Anand V Sahai; Rasmy Loungnarath

doi:10.1097/eus.0000000000000020

Safety and clinical efficacy of EUS-guided pelvic abscess drainage

Endosc Ultrasound. 2023 May-Jun;12(3):326-333. doi: 10.1097/eus.0000000000000020. Epub 2023 Jul 25.

Affiliations

¹ Digestive Surgery Service, Department of Surgery, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, QC, Canada.
² Department of Medicine, Division of Gastroenterology, CHUM, Montreal, QC, Canada.

Abstract

Background and objectives: EUS is a potential alternative for the drainage of abscesses. The aim of this study was to determine if EUS-guided pelvic abscess drainage is technically feasible, safe, and a valid option for abscess resolution.

Methods: We conducted a retrospective review from 2002 to 2020 at a single quaternary institution. EUS-guided pelvic abscess drainage via the transrectal route was performed in all patients with or without drain/stent placement. Technical and clinical success of EUS-guided pelvic abscess drainage was analyzed. Descriptive analyses and Fisher exact test were performed.

Results: Sixty consecutive patients were included in the study (53.5% male; mean age, 53.8 ± 17.9 years). Pelvic abscesses occurred mainly postoperatively (33 cases; 60.0%) and from complicated diverticulitis (14 cases; 23.3%). Mean diameter was 6.5 ± 2.4 cm (80% unilocular). Drainage was performed with EUS-guided stent placement (double-pigtail plastic or lumen-apposing metal) in 74.5% of cases and with aspiration alone for the remainder. Technical success occurred in 58 cases (97%). Of those with long-term follow-up after EUS-guided pelvic abscess drainage (n = 55; 91.7%), complete abscess resolution occurred in 72.7% of all cases. Recurrence occurred in 8 cases (14.5%) and persisted in 7 patients (12.5%), 7 of which were successfully retreated with EUS-guided pelvic abscess drainage. Accounting for these successful reinterventions, the overall rate of abscess resolution was 85.5%. Abscess resolution rate improved with drain placement (83%). Accounting for 7 repeat EUS-guided pelvic abscess drainages, overall abscess resolution improved. Two deaths occurred (3.4%) because of sepsis from failed source control in patients who had previously failed medical, radiological, and surgical treatment.

Conclusions: EUS-guided pelvic abscess drainage is technically feasible, safe, and an effective alternative to radiological or open surgical drainage. It also offers favorable clinical outcomes in different clinical situations.

Keywords: EUS; Lumen-apposing metal stent; Pelvic abscess; Transrectal drainage.