Medline ® Abstracts for References 3-5
of 'Therapeutic endoscopic ultrasound'
EUS-guided drainage of pelvic abscess (with video).
Varadarajulu S, Drelichman ER
Gastrointest Endosc. 2007;66(2):372.
BACKGROUND: Although pelvic abscesses have traditionally been drained by surgery or under radiologic guidance, a small subset of patients who are not candidates for these interventions require an alternate mode of drainage.
OBJECTIVE: Evaluate the efficacy of EUS for drainage of pelvic abscesses that could not be drained under US or CT guidance.
DESIGN: Prospective case series.
SETTING: Tertiary referral center.
PATIENTS: Four patients underwent EUS-guided drainage of pelvic abscesses that were not amenable for drainage by US and/or CT guidance.
INTERVENTIONS: A 10F drainage catheter was deployed in the abscess cavity under EUS guidance in all patients. The catheters were flushed periodically until resolution of the abscess was confirmed by CT imaging.
MAIN OUTCOME MEASUREMENTS: Resolution of a pelvic abscess on follow-up CT and improvement in clinical symptoms.
RESULTS: A drainage catheter was successfully placed in all 4 patients. The mean size of the abscess was 68 x 72 mm. There were no procedure-related complications. One patient died of worsening congestive heart failure 48 hours after the procedure. The abscesses resolved in the remaining 3 patients within a mean duration of 6 days, with complete symptom relief.
LIMITATIONS: A small number of patients and short duration of follow-up.
CONCLUSIONS: EUS-guided placement of drainage catheter is a minimally invasive technique for draining pelvic abscesses that are within the reach of the echoendoscope.
Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.
Drainage of deep pelvic abscesses using therapeutic echo endoscopy.
Giovannini M, Bories E, Moutardier V, Pesenti C, Guillemin A, Lelong B, Delpéro JR
BACKGROUND AND STUDY AIMS: The purpose of this study was to evaluate the clinical efficacy of endosonographically guided transrectal aspiration and drainage by plastic stent of deep pelvic abscesses, using a therapeutic echo endoscope device.
PATIENTS AND METHODS: Between September 2000 and June 2001, 12 patients (nine men, three women, mean age 67 years) were treated for a perirectal or a pelvic abscess using an endoscopic ultrasound (EUS) technique. The drainage of these fluid collections was performed under EUS guidance, using therapeutic EUS scopes with a large working channel.
RESULTS: No major complication occurred during this study. Transrectal stent insertion succeeded in nine patients. In three patients, only aspiration was possible. Among the nine patients in whom a stent was successfully introduced into the fluid collection, complete drainage without relapse was achieved in eight patients (mean follow-up 10.6 months, range 6-14 months). The stent was removed endoscopically after 3 to 6 months. Drainage was incomplete in one patient (with alarge abscess, diameter>8 cm), who subsequently underwent surgical drainage. However, two out of the three patients in whom aspiration alone was performed developed a recurrence of the abscess and required surgical treatment.
CONCLUSION: EUS-guided drainage of deep pelvic abscesses could offer an alternative treatment to surgery in the management of these postoperative complications.
Oncology Unit 1 and Endoscopic Department, Paoli-Calmettes Institute, 232 Boulevard Sainte-Marguerite BP 156, 13273 Marseille Cedex 9, France. firstname.lastname@example.org
Effectiveness of EUS in drainage of pelvic abscesses in 25 consecutive patients (with video).
Varadarajulu S, Drelichman ER
Gastrointest Endosc. 2009;70(6):1121.
BACKGROUND: Preliminary evidence suggests that EUS is a minimally invasive alternative to surgery and percutaneous techniques for drainage of pelvic abscesses. The EUS 2008 Working Group identified the technique as a priority for research and recommended its validation in a larger cohort of patients.
OBJECTIVE: To evaluate the rates of technical and treatment success, rate of recurrence, and complications of EUS-guided drainage of a pelvic abscess in a large cohort of patients.
STUDY DESIGN: Observational study.
SETTING: Academic tertiary referral center.
PATIENTS: Consecutive patients referred for EUS-guided drainage of a pelvic abscess that was not amenable to drainage under US or CT guidance.
METHODS: In patients with an abscess that measured less than 8 cm in size, two 7F transrectal stents were deployed. In patients with an abscess that measured 8 cm or more in size, an additional 10F drainage catheter was deployed. All patients underwent follow-up CT at 36 hours to assess response to therapy. If the abscess had decreased in size by more than 50%, the drainage catheters were discontinued and patients were discharged from the hospital. The stents were then retrieved by sigmoidoscopy at 2 weeks.
MAIN OUTCOME MEASUREMENTS: We evaluated the rates of technical and treatment success, rate of recurrence, and complications of the EUS-based approach. Technical success was defined as the ability to drain the abscess under EUS guidance. Treatment success was defined as symptom relief in association with complete resolution of the abscess on follow-up CT at 2 weeks. Recurrence was defined as the need for repeat EUS-guided drainage of a pelvic abscess within 90 days after the stent retrieval.
RESULTS: The procedure was technically successful in all 25 patients (100%) in whom it was attempted, and no complications were encountered. Mean size of the abscess was 68.5 x 52.4 mm. In addition to transrectal stents, a drainage catheter was deployed in 10 patients. Treatment was successful in 24 (96%) of 25 patients. The mean duration of the postprocedure hospital stay was 3.2 days. At a mean follow-up of 189 days (range 93-817), all 24 patients were doing well without abscess recurrence.
CONCLUSIONS: EUS is a minimally invasive, safe, and effective technique that affords long-term benefit for patients undergoing pelvic abscess drainage.
Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA. email@example.com