EUS Guided Drainage of Intra Abdominal Diverticular Abscess. A Case Series

Aims Diverticular disease is widespread worldwide. Mainstay approach is non operative treatment with bowel rest and broad-spectrum intravenous antibiotics. However, extra-colic abscess larger than 4 cm may require percutaneous trans-abdominal drainage. We report a single center case series of patients underwent to trans-luminal endoscopic ultrasound (EUS) guided drainage of pelvic abscess in diverticular disease with temporary placement of lumen apposing metal stent (LAMS).

Methods All patients referred to our tertiary center from January 2019 to July 2020 were enrolled in a prospective data base that was retrospectively analyzed. Procedural steps were as follow: preoperative CT scan, broad spectrum antibiotic therapy, EUS guided deployment of LAMS for 15 days, LAMS removal and deployment of pigtail stent in case of pseudo-cavity persistence. Clinical success was defined as complete radiological obliteration of the abscess and C-reactive protein normalization with no need for prolonged antibiotic or analgesic therapy for at least 6 months after the end of treatment.

Results 10 patients (6F) with an average of 59.6 years were enrolled with deployment of 10 LAMS. 1 patient was excluded after EUS evaluation due to abscess smaller than 3 cm. Median abscess size was 7.45 cm (SD 2.8). One patient had 2 separate collections that required the deployment of 2 LAMS Technical and clinical success was achieved in 88.8 % (8/9). No EUS related adverse event occurred.

Conclusions Management of diverticulitis has shifted from primary surgical intervention towards a non-operative approach of bowel rest and broad-spectrum intravenous antibiotics in conjunction with interventional procedures to drain abscesses whenever necessary. EUS guided drainage with LAMS for the management of diverticular abscesses seems an efficient treatment modality for encapsulated abscesses more than 4 cm in size and close to colonic wall. In expert centers it may avoid radiologic intervention and/or surgery in a relevant percentage of cases.

Citation: Cereatti F, Spota A, Donatelli G OP165 EUS GUIDED DRAINAGE OF INTRA ABDOMINAL DIVERTICULAR ABSCESS. A CASE SERIES. Endoscopy 2021; 53: S67.

Publication History

Article published online:
19 March 2021