Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
J Gastroenterol Hepatol. 2013 Apr;28(4):620-5. doi: 10.1111/jgh.12081.
Transrectal endoscopic ultrasound (EUS)-guided pelvic abscess drainage has been reported, but data on transcolonic drainage are scant.
To compare outcomes in patients undergoing transcolonic and transrectal drainage of abdominopelvic abscesses.
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.
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.
Except for patients with diverticular etiology, treatment of abdominopelvic abscess under EUS guidance is highly effective and safe for both routes.
经直肠内镜超声（EUS）引导下的盆腔脓肿引流已有报道，但经结肠引流的数据很少。
比较经结肠和经直肠引流腹盆腔脓肿的结果。
回顾性分析了 7 年来接受 EUS 引导下腹盆腔脓肿引流的所有患者。脓肿采用标准的单步 EUS 引导技术进行引流，部署双猪尾支架+导管。技术成功定义为支架或引流导管成功放置在脓肿腔内。治疗成功定义为在 2 周时随访 CT 显示脓肿消退，症状改善。
38 例患者中，11 例行经结肠引流，27 例行经直肠引流。两组患者的人口统计学、实验室值和中位脓肿大小（65 与 70mm，P=0.85）无差异。脓肿病因分别为术后 65.7%、憩室炎 13.1%、穿孔性内脏 10.5%和其他原因 10.5%。技术成功率（每组均为 100%）、治疗成功率（70%与 96.3%，P=0.052）和并发症发生率（均无）无差异。经结肠引流组有 3 例和经直肠引流组有 1 例因内镜引流失败而行手术（27.3%与 3.7%，P=0.06）。按病因评估时，憩室炎脓肿的治疗成功率明显低于其他病因（25%与 97%，P=0.002）。中位随访 1228.5 天（四分位距=131-1660），所有治疗成功的患者均恢复良好，无复发。
除憩室炎病因外，EUS 引导下治疗腹盆腔脓肿两种途径均高度有效且安全。
