Comparison of outcomes between endoscopic ultrasound‐guided transcolonic and transrectal drainage of abdominopelvic abscesses. Issue 4 (25th March 2013)

• Record Type: Journal Article
• Authors: Ramesh, Jayapal; Bang, Ji Young; Trevino, Jessica; Varadarajulu, Shyam
• Is Part Of: Journal of gastroenterology and hepatology. Volume 28:Issue 4(2013:Apr.)
• Page Start: 620
• Page End: 625
• Publication Date: 2013-03-25
• Subjects: EUS‐guided drainage -- diverticular abscess -- interventional ultrasonography -- pelvic abscess; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Liver Diseases -- Periodicals; 616.33
• DOI: 10.1111/jgh.12081
• Languages: English
• ISSNs: 0815-9319

Abstract

Abstract: Background: Transrectal endoscopic ultrasound (EUS)‐guided pelvic abscess drainage has been reported, but data on transcolonic drainage are scant. Aim: To compare outcomes in patients undergoing transcolonic and transrectal drainage of abdominopelvic abscesses. Methods: Retrospective study of all patients who underwent EUS‐guided drainage of abdominopelvic abscesses over a 7‐year period. Abscesses were drained by a standard single‐step EUS‐guided technique with deployment of double‐pigtail stents ± catheters. Technical success was defined as successful placement of stents or drainage catheters within the abscess cavity. Treatment success was defined as resolution of abscess on follow‐up computed tomography at 2 weeks with symptom improvement. Results: Of 38 patients, 11 underwent transcolonic and 27 transrectal drainages. There was no difference in patient demographics, laboratory values, and median abscess size (65 vs 70 mm, P = 0.85) between the two cohorts. Etiology of abscess was postsurgical in 65.7%, diverticulitis in 13.1%, perforated viscus in 10.5%, and other causes in 10.5%. There was no difference in rates of technical success (100% in each cohort), treatment success (70% vs 96.3%, P = 0.052), or complications (none). Three patients in the transcolonic and one in the transrectal cohort underwent surgery for failed endoscopic drainage (27.3% vs 3.7%, P = 0.06). When evaluated by etiology, treatment success for diverticular abscess was significantly lower compared with others (25% vs 97%, P = 0.002). At a median follow‐up of 1228.5 days (interquartile range = 131–1660), all patients with treatment success were doing well with no recurrence. Conclusion: Except for patients with diverticular etiology, treatment of abdominopelvic abscess under EUS guidance is highly effective and safe for both routes.