Velasquez-Rodriguez Julio G, Loras Carme, Maisterra Sandra, Colán-Hernández Juan, Busquets Juli, Gornals Joan B
Endoscopy Unit, Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Catalonia, Spain.
Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.
Ther Adv Gastrointest Endosc. 2024 Oct 13;17:26317745241287319. doi: 10.1177/26317745241287319. eCollection 2024 Jan-Dec.
Endoscopic management of abdominal collections includes endoscopic ultrasound (EUS)-guided transmural drainage, transpapillar via endoscopic retrograde cholangiopancreatography (ERCP), and EUS-guided simple puncture-aspiration (SPA). The latter is little reported, and there are some doubts about its real usefulness.
The aim of this study was to assess the effectiveness of EUS-guided SPA as a first-line approach for treatment in selected abdominal collections.
Retrospective observational study performed in two tertiary centers (Barcelona area).
Inclusion of all consecutive patients with abdominal collections that underwent EUS-guided SPA from July 2007 to July 2021. The decision was based on endoscopist criteria and collection characteristics. Clinical success was defined as avoidance of an additional interventional approach (endoscopic stenting, percutaneous drainage, surgery).
Of 241 patients with abdominal collections treated endoscopically, 55 were included for analysis (mean age, 56 ± 12 years). Collection features: mean size 63.3 ± 24.8 mm; positive culture in 22 (40%) and pancreatic nature in 45 (81.8%). EUS-SPA was performed successfully in all cases, and clinical success was achieved in 76.3% (95% confidence interval (CI), 65.5-87.3) of cases (-42/55). The most frequently used needle size was 19 Ga (85%). A nonsignificant trend for success was detected for noninfected collections (84.8 vs 63.6; = 0.07) and lower size (mean ± SD; 60.2 ± 22.9 vs 73.8 ± 29 mm; = 0.09). Two related adverse events were detected: one bleeding and one abdominal pain. Recurrence was detected in five pseudocysts after clinical success. Median follow-up was 629 days (IQR 389-877).
EUS-SPA of selected abdominal collections seems to be a safe and effective technique, avoiding a more aggressive strategy such as transmural stenting. EUS-SPA may be a viable alternative in collections with limited size and preferably noninfected.
腹部积液的内镜治疗方法包括内镜超声（EUS）引导下的透壁引流、经内镜逆行胰胆管造影（ERCP）的经乳头引流以及EUS引导下的单纯穿刺抽吸（SPA）。后者报道较少，其实际效用存在一些疑问。
本研究旨在评估EUS引导下的SPA作为治疗特定腹部积液一线方法的有效性。
在两个三级中心（巴塞罗那地区）进行的回顾性观察研究。
纳入2007年7月至2021年7月期间所有接受EUS引导下SPA治疗的连续性腹部积液患者。该决策基于内镜医师的标准和积液特征。临床成功定义为避免采取额外的介入方法（内镜支架置入、经皮引流、手术）。
在内镜治疗的241例腹部积液患者中，55例纳入分析（平均年龄56±12岁）。积液特征：平均大小63.3±24.8mm；22例（40%）培养结果为阳性，45例（81.8%）为胰腺源性。所有病例EUS-SPA均成功实施，76.3%（95%置信区间（CI），65.5 - 87.3）的病例（42/55）取得临床成功。最常用的穿刺针规格为19G（85%）。未感染的积液（84.8对63.6；P = 0.07）和较小尺寸（平均值±标准差；60.2±22.9对73.8±29mm；P = 0.09）的成功趋势不显著。检测到两例相关不良事件：一例出血和一例腹痛。临床成功后，五个假性囊肿出现复发。中位随访时间为629天（四分位间距389 - 877）。
对特定腹部积液进行EUS-SPA似乎是一种安全有效的技术，可避免采用如透壁支架置入等更激进的策略。EUS-SPA对于尺寸有限且最好未感染的积液可能是一种可行的替代方法。
