Endoscopic Ultrasound-Guided Drainage of Difficult-to-Access Liver Abscesses: A Large Single-Center Experience
Year: 2025
Type: article
Study design: Observational Study
Abstract: Endoscopic ultrasound (EUS)-guided drainage can be a minimally invasive alternative approach in draining radiologically inaccessible liver abscesses. However, experience with EUS-guided drainage is limited with no guidelines available. The objective of this study was to share our experience in EUS-guided drainage of radiologically inaccessible liver abscesses. Retrospective analysis of prospectively maintained database of patients who underwent EUS-guided liver abscess drainage from 2017 to May 2024 was done. Demographics, clinical data, procedural data, and adverse events were collected. Abscesses were analyzed for their location, number, size, puncture distance, indication of drainage, route of access, and the endoprosthesis used for drainage. Results were reported as mean or median (range) for quantitative variable and percentage for categorical variable. A total of 46 patients (44 males and 2 females) underwent EUS-guided liver abscess drainage. Transmural drainage was done in 31 (67.4%) and aspiration in 15 (32.6%) patients. The mean size of abscess collection was 6.55 ± 0.33 cm. The puncture distance was <2 cm in 38, 2–4 cm and >4 cm in 4 each. Location of abscess was caudate lobe in 10 (24.4%), segment 2 in 4 (8.7%), segment 3 in 11 (23.9%), segment 4 in 7 (15.2%), segment 5 in 3 (6.5%), segment 6 in 4 (8.7%), segment 7 in 1(2.17%), and segment 8 in 6 (13%). Access was transesophageal in 7 (15.2%), transduodenal in 17 (36.9%), and transgastric in 22 (47.8%). Seven patients underwent trans-segmental drainage. Segment 8 was accessed through segment 5 or caudate lobe in three patients each, and segment 7 through segment 6 in one patient. 10F nasocystic drain (NCD) was used as endoprosthesis in all patients who underwent transmural drainage except one. Technical and clinical success of EUS-guided drainage was 100%. EUS-guided drainage with its excellent safety profile and clinical success should always be considered for draining radiologically inaccessible liver abscesses before contemplating surgical drainage. 10F NCD works well as endoprosthesis with excellent results irrespective of approach, location, thick abscess contents, and in ruptured abscesses. EUS-guided trans-segmental drainage is technically feasible and clinically effective.
Source: Journal of Digestive Endoscopy
Author: Sharad Chandra
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4408601914