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Safety and clinical efficacy of EUS–guided pelvic abscess drainage

BACKGROUND AND OBJECTIVES: EUS is a potential alternative for the drainage of abscesses. The aim of this study was to determine if EUS-guided pelvic abscess drainage is technically feasible, safe, and a valid option for abscess resolution. METHODS: We conducted a retrospective review from 2002 to 20...

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Autores principales: Al Khaldi, Maher, Ponomarev, Alexander, Richard, Carole, Dagbert, François, Sebajang, Herawaty, Schwenter, Frank, Wassef, Ramses, De Broux, Éric, Ratelle, Richard, Paquin, Sarto C., Sahai, Anand V., Loungnarath, Rasmy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10437202/
https://www.ncbi.nlm.nih.gov/pubmed/37693116
http://dx.doi.org/10.1097/eus.0000000000000020
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author Al Khaldi, Maher
Ponomarev, Alexander
Richard, Carole
Dagbert, François
Sebajang, Herawaty
Schwenter, Frank
Wassef, Ramses
De Broux, Éric
Ratelle, Richard
Paquin, Sarto C.
Sahai, Anand V.
Loungnarath, Rasmy
author_facet Al Khaldi, Maher
Ponomarev, Alexander
Richard, Carole
Dagbert, François
Sebajang, Herawaty
Schwenter, Frank
Wassef, Ramses
De Broux, Éric
Ratelle, Richard
Paquin, Sarto C.
Sahai, Anand V.
Loungnarath, Rasmy
author_sort Al Khaldi, Maher
collection PubMed
description BACKGROUND AND OBJECTIVES: EUS is a potential alternative for the drainage of abscesses. The aim of this study was to determine if EUS-guided pelvic abscess drainage is technically feasible, safe, and a valid option for abscess resolution. METHODS: We conducted a retrospective review from 2002 to 2020 at a single quaternary institution. EUS–guided pelvic abscess drainage via the transrectal route was performed in all patients with or without drain/stent placement. Technical and clinical success of EUS-guided pelvic abscess drainage was analyzed. Descriptive analyses and Fisher exact test were performed. RESULTS: Sixty consecutive patients were included in the study (53.5% male; mean age, 53.8 ± 17.9 years). Pelvic abscesses occurred mainly postoperatively (33 cases; 60.0%) and from complicated diverticulitis (14 cases; 23.3%). Mean diameter was 6.5 ± 2.4 cm (80% unilocular). Drainage was performed with EUS-guided stent placement (double-pigtail plastic or lumen-apposing metal) in 74.5% of cases and with aspiration alone for the remainder. Technical success occurred in 58 cases (97%). Of those with long-term follow-up after EUS-guided pelvic abscess drainage (n = 55; 91.7%), complete abscess resolution occurred in 72.7% of all cases. Recurrence occurred in 8 cases (14.5%) and persisted in 7 patients (12.5%), 7 of which were successfully retreated with EUS-guided pelvic abscess drainage. Accounting for these successful reinterventions, the overall rate of abscess resolution was 85.5%. Abscess resolution rate improved with drain placement (83%). Accounting for 7 repeat EUS-guided pelvic abscess drainages, overall abscess resolution improved. Two deaths occurred (3.4%) because of sepsis from failed source control in patients who had previously failed medical, radiological, and surgical treatment. CONCLUSIONS: EUS–guided pelvic abscess drainage is technically feasible, safe, and an effective alternative to radiological or open surgical drainage. It also offers favorable clinical outcomes in different clinical situations.
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spelling pubmed-104372022023-09-08 Safety and clinical efficacy of EUS–guided pelvic abscess drainage Al Khaldi, Maher Ponomarev, Alexander Richard, Carole Dagbert, François Sebajang, Herawaty Schwenter, Frank Wassef, Ramses De Broux, Éric Ratelle, Richard Paquin, Sarto C. Sahai, Anand V. Loungnarath, Rasmy Endosc Ultrasound Original Research BACKGROUND AND OBJECTIVES: EUS is a potential alternative for the drainage of abscesses. The aim of this study was to determine if EUS-guided pelvic abscess drainage is technically feasible, safe, and a valid option for abscess resolution. METHODS: We conducted a retrospective review from 2002 to 2020 at a single quaternary institution. EUS–guided pelvic abscess drainage via the transrectal route was performed in all patients with or without drain/stent placement. Technical and clinical success of EUS-guided pelvic abscess drainage was analyzed. Descriptive analyses and Fisher exact test were performed. RESULTS: Sixty consecutive patients were included in the study (53.5% male; mean age, 53.8 ± 17.9 years). Pelvic abscesses occurred mainly postoperatively (33 cases; 60.0%) and from complicated diverticulitis (14 cases; 23.3%). Mean diameter was 6.5 ± 2.4 cm (80% unilocular). Drainage was performed with EUS-guided stent placement (double-pigtail plastic or lumen-apposing metal) in 74.5% of cases and with aspiration alone for the remainder. Technical success occurred in 58 cases (97%). Of those with long-term follow-up after EUS-guided pelvic abscess drainage (n = 55; 91.7%), complete abscess resolution occurred in 72.7% of all cases. Recurrence occurred in 8 cases (14.5%) and persisted in 7 patients (12.5%), 7 of which were successfully retreated with EUS-guided pelvic abscess drainage. Accounting for these successful reinterventions, the overall rate of abscess resolution was 85.5%. Abscess resolution rate improved with drain placement (83%). Accounting for 7 repeat EUS-guided pelvic abscess drainages, overall abscess resolution improved. Two deaths occurred (3.4%) because of sepsis from failed source control in patients who had previously failed medical, radiological, and surgical treatment. CONCLUSIONS: EUS–guided pelvic abscess drainage is technically feasible, safe, and an effective alternative to radiological or open surgical drainage. It also offers favorable clinical outcomes in different clinical situations. Lippincott Williams & Wilkins 2023 2023-07-25 /pmc/articles/PMC10437202/ /pubmed/37693116 http://dx.doi.org/10.1097/eus.0000000000000020 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc on behalf of Scholar Media Publishing. https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access article distributed under the Creative Commons Attribution-NonCommercial-ShareAlike License 4.0 (CC BY-NC-SA) (https://creativecommons.org/licenses/by-nc-sa/4.0/) which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Research
Al Khaldi, Maher
Ponomarev, Alexander
Richard, Carole
Dagbert, François
Sebajang, Herawaty
Schwenter, Frank
Wassef, Ramses
De Broux, Éric
Ratelle, Richard
Paquin, Sarto C.
Sahai, Anand V.
Loungnarath, Rasmy
Safety and clinical efficacy of EUS–guided pelvic abscess drainage
title Safety and clinical efficacy of EUS–guided pelvic abscess drainage
title_full Safety and clinical efficacy of EUS–guided pelvic abscess drainage
title_fullStr Safety and clinical efficacy of EUS–guided pelvic abscess drainage
title_full_unstemmed Safety and clinical efficacy of EUS–guided pelvic abscess drainage
title_short Safety and clinical efficacy of EUS–guided pelvic abscess drainage
title_sort safety and clinical efficacy of eus–guided pelvic abscess drainage
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10437202/
https://www.ncbi.nlm.nih.gov/pubmed/37693116
http://dx.doi.org/10.1097/eus.0000000000000020
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