Drainage of Pelvic Fluid Collections Under Echo-Endoscopy Using Lumen-Apposing Metal Stents: A Retrospective Multicenter Study

Aims Pelvic fluid collections (PFC), which are mainly abscesses, often arise post-surgically or secondary to abdominal infections —most commonly due to complicated diverticulitis— and represent a clinical challenge. While percutaneous drainage is the current standard of care, this procedure has its limitations, such as access difficulties and patient discomfort, particularly with transgluteal approach. Endoscopic ultrasound (EUS)-guided drainage with lumen-apposing metal stents (LAMS) offers a minimally invasive alternative. This study evaluates the efficacy and safety of EUS-guided transrectal and transigmoidal drainage using LAMS for PFC.

Methods This retrospective multicenter study was conducted across 12 expert centers in France and Belgium, involving patients who underwent EUS-guided drainage of symptomatic PFC using LAMS between December 2016 and February 2024. Primary outcome was technical and clinical success, respectively defined by successful drainage of the collection without severe per-procedural adverse events (AEs) and resolution of symptoms associated with a reduction of over 75% in the initial collection size, on the follow-up CT scan conducted between week 4 and 6 after drainage. Secondary outcomes included procedure-related and late-onset AE described using the AGREE classification, and long-term recurrence rates.

Results Fifty-nine patients (58% female; median age 59.3 years) were included, predominantly with post-operative collections (42.8%) and collections following diverticulitis (28.6%). Technical success was achieved in 100% of cases (59/59). Clinical success was observed in 94.5% of patients (52/55), with a median time to success of 21 days (IQR 10.25-29.75). The stent was removed after a median period of 28 days (IQR 19.2–36) in 51 patients; 3 cases of spontaneous migration were observed, and one patient died with the stent in place from causes unrelated to the procedure. AE occurred in 12.7% of cases (7/55), with a median delay of 10 days (IQR 10,2-29,8). One patient (1.8%) experienced a grade II AE, while six patients (10.9%) had grade IIIa AE, requiring endoscopic reintervention but no surgical management. There were no severe AEs (grade IIIb, IV, or V). Most complications, including LAMS migration and pelvic pain, were managed endoscopically. Two patients (3.6%) experienced recurrence of the PFC within 6 months. The median follow-up duration was 213 days (IQR 75-510.5).

Conclusions In this study, which is the largest to date, EUS-guided drainage of PFC using LAMS appears to be an effective and safe alternative to traditional approaches, with excellent technical and clinical success rates. The low recurrence rate and absence of severe AEs suggest that LAMS could be considered as a first-line treatment for PFC in suitable candidates. The precise role of this approach relative to percutaneous drainage remains to be determined in larger-scale studies.

Publication History

Article published online:
27 March 2025