USEFULNESS OF EUS-GUIDED SINGLE-STEP COMPLETE-ASPIRATION IN THE MANAGEMENT OF ABDOMINAL COLLECTIONS: EXPERIENCE FROM 2 TERTIARY CENTRES

Aims Endoscopic management of abdominal collections include endoscopic ultrasound (EUS)-guided transmural drainage, transpapillary drainage via ERCP, and EUS-guided single-step complete-aspiration (SSCA). The latter is little reported, and there are some doubts about its real effectiveness.

Methods Database review and retrospective cohort identification among two tertiary Spanish hospitals that includes abdominal collections treated by EUS-guided SSCA. The decision to apply this strategy was based on endoscopist criteria. Treatment by transmural and/or transpapillary drainage were excluded. Technical success was defined as needle access inside the collection and complete aspiration till collapse. Clinical success was defined as reduction≥50% of initial size or decrease<50% with clinical improvement. Failure: increased collection or need for re-intervention. Other variables: demographics, collection features, re-intervention or safety.

Results

Table 1

Variables, features	Success	p
Sex (Men/Female), n (%)	14 (45)/10 (47)	0,86
Etiology (Pancreatic/Non-pancreatic), n (%)	18 (41)/6 (66)	0,17
Microbiology (Positive/Negative), n (%)	8 (38)/ 15 (55)	0,23
Mean collection size (success group/non-success group), mm (SD)	54,5 (16,8)/51,1 (26,1)	0,10

Fifty-two patients were included (31 men, mean age 56-y(SD 13.1)). Collection data: mean size 56-mm(SD 13.1); positive culture in 40%; pancreatic nature in 82% (n-43). Clinical success of 46% (one attempt) and 55% after a second attempt. Adverse events were detected in 5%. Most needle type used, 19 G (87%). Mean follow-up, 467-days (SD 437). No identification of any factor associated with clinical success. Table 1. Failed-treatment approach: 40% conservative vs 60% re-intervention, of which 66.6% endoscopic (second SSCA in 4; pigtail placement in 3, lumen-apposing stent in 1), in 25% percutaneous and 8.3% surgery.

Conclusions In a percentage of selected abdominal collections treatment by EUS-SSCA could save a more aggressive strategy. No specific factor associated with failure of this strategy has been identified.

Publication History

Article published online:
14 April 2022