RETROSPECTIVE COHORT STUDY EVALUATING CLINICAL OUTCOMES OF PERCUTANEOUS AND ENDOSCOPIC ULTRASOUND-GUIDED DRAINAGE OF UPPER ABDOMINAL ABSCESSES

Aims:

Although percutaneous drainage (PTD) is recommended as first line treatment for intraabdominal abscesses, EUS-guided drainage (EUS-D) has been successfully employed in hepatic and postsurgical intraabdominal abscesses. We aimed at comparing safety, feasibility and clinical outcomes of upper abdominal abscesses undergoing percutaneous or EUS-guided drainage.

Methods:

We present a single center retrospective cohort study including all consecutive patients undergoing PTD or EUS-D of upper abdominal abscesses between January 2012 and June 2017. Peripancreatic fluid collections related to acute pancreatitis and subjects with a previous history of liver transplantation were excluded.

Results:

We included 80 patients, 18 EUS-D and 62 PTD. There were no differences between cohorts regarding age, sex and etiology. Size was larger in the PTD group (80 vs. 65.5 mm, p = 0.04) and perivesicular location was more frequent in the PTD group (24.2% vs. 11.1%, p = 0.003).

The transgastric route was chosen in 14 (77.8%) EUS-D. Metal stents were deployed in 16 (89.9%) subjects (9 lumen apposing metal stents and 7 SEMS). Double pig-tail plastic stents were placed in 6 (33.3%) patients and lavage/debridement was performed in 5 (27.8%).

Procedure outcomes are shown in table 1. There were 4 (22.2%) adverse events (3 mild hemorrhages and one perforation solved during the endoscopic procedure) in the EUS-D group and 13 (21%) in the PTD group (p = 0.91), 7 of them severe.

Tab. 1:

Outcomes

	EUS-guided drainage (n = 18)	Percutaneous drainage (n = 62)	p value
Technical success, n (%)	16 (88.9%)	60 (96.8%)	0.22
Clinical success, n (%)	16 (88.9%)	51 (82.3%)	0.50
Time to clinical success (days), med (IQR)	17.5 (5.5 – 25.5)	17 (7 – 27)	0.71
Relapse, n (%)	0	7 (11.3%)	0.11

Conclusions:

EUS-D presents a similar efficacy compared to PTD, with a non-significant reduction in the number of relapses. These results warrant the development of prospective randomized trials comparing both approaches.