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
Digestive Surgery Service, Department of Surgery, Centre Hospitalier de l'Université de Montreal (CHUM), Montreal, QC, Canada.
Department of Medicine, Division of Gastroenterology, CHUM, Montreal, QC, Canada.
Endosc Ultrasound. 2023 May-Jun;12(3):326-333. doi: 10.1097/eus.0000000000000020. Epub 2023 Jul 25.
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.
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.
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 ( = 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.
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.
超声内镜引导下穿刺引流术（EUS）是一种可用于脓肿引流的潜在替代方法。本研究旨在确定EUS引导下盆腔脓肿引流在技术上是否可行、安全，以及是否是脓肿消退的有效选择。
我们对一家单一的四级医疗机构2002年至2020年的数据进行了回顾性分析。所有患者均采用经直肠途径进行EUS引导下盆腔脓肿引流，部分患者放置引流管/支架。分析EUS引导下盆腔脓肿引流的技术和临床成功率。进行描述性分析和Fisher精确检验。
本研究共纳入60例患者（男性占53.5%；平均年龄53.8±17.9岁）。盆腔脓肿主要发生在术后（33例，占60.0%）和复杂性憩室炎（14例，占23.3%）。平均直径为6.5±2.4cm（80%为单房脓肿）。74.5%的病例采用EUS引导下放置支架（双猪尾塑料支架或管腔贴附金属支架）进行引流，其余病例仅行穿刺抽吸。58例（97%）获得技术成功。在EUS引导下盆腔脓肿引流后进行长期随访的患者中（n = 55，占91.7%），72.7%的患者脓肿完全消退。8例（14.5%）复发，7例（12.5%）持续存在，其中7例通过EUS引导下盆腔脓肿引流成功再次治疗。计入这些成功的再次干预后，脓肿总体消退率为85.5%。放置引流管后脓肿消退率提高（83%）。计入7次重复的EUS引导下盆腔脓肿引流，总体脓肿消退情况有所改善。2例（3.4%）患者因先前药物、放射和手术治疗均失败，感染源控制不佳导致败血症死亡。
EUS引导下盆腔脓肿引流在技术上可行、安全，是放射或开放手术引流的有效替代方法。在不同临床情况下也能提供良好的临床效果。
