Long-term outcome of endoscopic ultrasound-guided pelvic abscess drainage: a two-center series

Abstract

Background and study aim Endoscopic ultrasound (EUS)-guided pelvic abscess drainage has been reported but long-term data remain limited. This two-center study evaluated long-term outcome of EUS-guided pelvic abscess drainage.

Patients and methods Between May 2003 and December 2015, 37 consecutive patients were treated for perirectal or perisigmoid abscesses via EUS-guided drainage using plastic or lumen-apposing metal stent (LAMS). Clinical success was defined as complete resolution of the abscess on follow-up computed tomography (CT) scan at 4 weeks with symptom relief. Long-term success was defined as abscess resolution without the need for surgery and without recurrence on long-term follow-up (> 12 months).

Results Median abscess size was 60 mm (interquartile range 41 – 70). Causes were postsurgical (n = 31, 83.8 %) or secondary to medical conditions (n = 6, 16.2 %). EUS-guided drainage involved needle aspiration (n = 4), plastic stent placement (n = 29) or LAMS placement (n = 4 patients). Technical and clinical success was achieved in 37 patients (100 %; 95 % confidence interval [CI] 91 – 100) and 34 patients (91.9 %; 95 %CI 78 – 98), respectively (5 patients needed a second EUS-guided intervention within 14 days after drainage). One patient required surgery and one required best supportive care owing to persistent abscess. Early complications were perforation requiring surgery (n = 1), stent migration (n = 1), and rectal discomfort (n = 1). At a median follow-up of 64 months (IQR 19 – 81), two patients experienced abscess recurrence, at 3 and 12 months, respectively, and were treated surgically. Long-term success was achieved in 32 of 37 patients (86.5 %; 95 %CI 71 – 95).

Conclusion EUS-guided drainage of pelvic abscess is safe, has good long-term outcome, and should be considered as an alternative to percutaneous and surgical drainage.

• References

• 1 Golub R, Golub RW, Cantu Jr R. et al. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 1997; 184: 364-372
• 2 Lareau SM, Beigi RH. Pelvic inflammatory disease and tubo-ovarian abscess. Infect Dis Clin North Am 2008; 22: 693-708
• 3 Lee H, Kim Y-H, Chang DK. et al. Nonsurgical treatment of abdominal or pelvic abscess in consecutive patients with Crohn’s disease. Dig Liver Dis 2006; 38: 659-664
• 4 Granberg S, Gjelland K, Ekerhovd E. The management of pelvic abscess. Best Pract Res Clin Obstet Gynaecol 2009; 23: 667-678
• 5 McGahan JP, Wu C. Sonographically guided transvaginal or transrectal pelvic abscess drainage using the trocar method with a new drainage guide attachment. Am J Roentgenol 2008; 191: 1540-1544
• 6 Saokar A, Arellano RS, Gervais DA. et al. Transvaginal drainage of pelvic fluid collections: results, expectations, and experience. Am J Roentgenol 2008; 191: 1352-1358
• 7 Hovsepian DM. Transrectal and transvaginal abscess drainage. J Vasc Interv Radiol 1997; 8: 501-515
• 8 Sudakoff GS, Lundeen SJ, Otterson MF. Transrectal and transvaginal sonographic intervention of infected pelvic fluid collections: a complete approach. Ultrasound Q 2005; 21: 175-185
• 9 Laganà D, Carrafiello G, Mangini M. et al. Image-guided percutaneous treatment of abdominal-pelvic abscesses: a 5-year experience. Radiol Med 2008; 113: 999-1007
• 10 Harisinghani MG, Gervais DA, Maher MM. et al. Transgluteal approach for percutaneous drainage of deep pelvic abscesses: 154 cases. Radiology 2003; 228: 701-705
• 11 Giovannini M, Bories E, Moutardier V. et al. Drainage of deep pelvic abscesses using therapeutic echo endoscopy. Endoscopy 2003; 35: 511-514
• 12 Varadarajulu S, Drelichman ER. EUS-guided drainage of pelvic abscess (with video). Gastrointest Endosc 2007; 66: 372-376
• 13 Trevino JM, Drelichman ER, Varadarajulu S. Modified technique for EUS-guided drainage of pelvic abscess (with video). Gastrointest Endosc 2008; 68: 1215-1219
• 14 Varadarajulu S, Drelichman ER. Effectiveness of EUS in drainage of pelvic abscesses in 25 consecutive patients. Gastrointest Endosc 2009; 70: 1121-1127
• 15 Puri R, Eloubeidi MA, Sud R. et al. Endoscopic ultrasound-guided drainage of pelvic abscess without fluoroscopy guidance. J Gastro Hepatol 2010; 25: 1416-1419
• 16 Hadithi M, Bruno MJ. Endoscopic ultrasound-guided drainage of pelvic abscess: a case series of 8 patients. World J Gastrointest Endosc 2014; 6: 373-378
• 17 Ramesh J, Bang JY, Trevino J. et al. Comparison of outcomes between endoscopic ultrasound-guided transcolonic and transrectal drainage of abdominopelvic abscesses. J Gastroenterol Hepatol 2013; 28: 620-625
• 18 Puri R, Choudhary S, Kotecha H. et al. Endoscopic ultrasound-guided pelvic and prostatic abscess drainage: experience in 30 patients. Indian J Gastroenterol 2014; 33: 410-413
• 19 Yeh CY, Changchien CR, Wang J-Y. et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 2005; 241: 9-13
• 20 Katsuno H, Shiomi A, Ito M. et al. Comparison of symptomatic anastomotic leakage following laparoscopic and open low anterior resection for rectal cancer: a propensity score matching analysis of 1014 consecutive patients. Surg Endosc 2016; 30: 2848-2856
• 21 Seewald S, Ang TL, Teng KY. et al. Endoscopic ultrasound-guided drainage of abdominal abscesses and infected necrosis. Endoscopy 2009; 41: 166-174
• 22 Itoi T, Binmoeller KF, Shah J. et al. Clinical evaluation of a novel lumen-apposing metal stent for endosonography-guided pancreatic pseudocyst and gallbladder drainage (with videos). Gastrointest Endosc 2012; 75: 870-876
• 23 Luigiano C, Togliani T, Cennamo V. et al. Transrectal endoscopic ultrasound-guided drainage of pelvic abscess with placement of a fully covered self-expandable metal stent. Endoscopy 2013; 45: E245-246
• 24 Kawakami H, Kuwatani M, Kawahata S. et al. Endoscopic ultrasound-guided pelvic abscess drainage using a dedicated, wide, flared-end, fully covered self-expandable metal stent. Endoscopy 2015; 47: E265-266
• 25 Fernandez-Urien I, Vila JJ, Jimenez FJ. Endoscopic ultrasound-guided drainage of pelvic collections and abscesses. World J Gastrointest Endosc 2010; 2: 223-227
• 26 Piraka C, Shah RJ, Fukami N. et al. EUS-guided transesophageal, transgastric, and transcolonic drainage of intra-abdominal fluid collections and abscesses. Gastrointest Endosc 2009; 70: 786-792
• 27 Prasad GA, Varadarajulu S. Endoscopic ultrasound-guided abscess drainage. Gastrointest Endosc Clin N Am 2012; 22: 281-290
• 28 Will U, Fueldner F, Kern C. et al. EUS-guided bile duct drainage (EUBD) in 95 patients. Ultraschall Med 2015; 36: 276-283
• 29 Holt B, Vadarajulu S. Endoscopic ultrasound-guided pelvic abscess drainage (with video). J Hepatobiliary Pancreat Sci 2015; 22: 12-15