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1
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Wahba G, Lee JH. Updates on therapeutic endoscopic ultrasound. Curr Opin Gastroenterol 2025; 41:16-28. [PMID: 39560626 DOI: 10.1097/mog.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2024]
Abstract
PURPOSE OF REVIEW Multiple endoscopic ultrasound (EUS) guided therapeutic interventions have been developed for the management of benign and malignant pancreaticobiliary and gastrointestinal luminal pathology. Recent high-quality evidence is increasingly validating these interventions and positioning them within evidence-based therapeutic algorithms. RECENT FINDINGS Here we review therapeutic EUS-guided interventions including pancreatic fluid collection drainage, gastroenterostomy, biliary drainage, pancreatic duct drainage and gallbladder drainage. The most up-to-date high-quality evidence supporting these interventions is presented including comparative data with other conventional treatment options. Newer emerging interventions such as tumor ablation are also reviewed. Current controversies and future avenues for research are discussed. The key role of EUS-guided interventions in managing pancreaticobiliary pathology in patients with a surgically altered anatomy is highlighted. SUMMARY Multiple EUS therapeutic interventions have evolved from experimental or rescue options to now well established first- and second-line interventions over other endoscopic, percutaneous and surgical alternatives with the support of high-quality data. Further research is needed to better optimize patient selection and guide long term postintervention follow-up.
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Affiliation(s)
- George Wahba
- Department of Gastroenterology, Hepatology & Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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2
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Hiyama K, Kirino I, Fukui Y. A case of bladder and pelvic dead space inflammation successfully treated with endoscopic ultrasound drainage. Clin Case Rep 2023; 11:e8019. [PMID: 37808570 PMCID: PMC10558673 DOI: 10.1002/ccr3.8019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/10/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023] Open
Abstract
Key Clinical Message Interventional endoscopic ultrasound (EUS) is effective not only for biopsy, but also for abscess drainage. We report the first use of EUS to drain inflammation of the bladder and pelvic dead space through the ileal conduit. EUS-guided drainage is effective in treating postoperative abscesses and should be employed more routinely. Abstract The patient was a 77-year-old man with a vesicoureteral fistula. An ileal conduit was placed after abdominoperineal resection and partial bladder resection for local, postoperative recurrence of rectal cancer. During postoperative chemotherapy, the patient developed a high-grade fever and after a thorough examination, he was diagnosed with bladder and pelvic dead-space inflammation. All urine flowed through the ileal conduit, and it was assumed that secretions from the residual bladder and prostate gland had accumulated in the bladder and pelvic cavity, resulting in infection. A transcutaneous drain was inserted through the perineum and the infection was controlled, but it flared up again after the drain was removed. We concluded that long-term drainage was necessary and successfully controlled the infection by placing a plastic stent through the ileal conduit into the bladder and pelvic dead space under ultrasound endoscopy. This is the first report of ultrasound endoscopic drainage of an abscess through the ileal conduit.
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Affiliation(s)
| | | | - Yasuo Fukui
- Department of SurgeryAtago HospitalKochiJapan
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3
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Goerl T, Speck C, Gehring A, Wiessner R. Endoscopic Ultrasound-Guided Transrectal Pelvic Abscess Drainage (EUS-PAD) - Bridging to Surgery: Report of Two Cases. Surg J (N Y) 2023; 9:e145-e148. [PMID: 38197093 PMCID: PMC10730280 DOI: 10.1055/s-0043-1777791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024] Open
Abstract
Background Currently, the methods for drainage of pelvic abscess primarily use computed tomography- or ultrasound-guided percutaneous drainage or surgical drainage. Endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) is an alternative, minimally invasive tool to drain an abscess, localized close to the rectum or left colon, and therefore not accessible by other means. Methods We report on the success of endoscopic ultrasound-guided drainage of peridiverticulitic abscess based on the two cases presented here. Using endoscopic ultrasound guidance an aspiration of the abscess from the endoluminal could be realized. After successive balloon dilatation via a guidewire while using X-ray imaging, the placement of pigtail or flap stent was performed. In addition, conservative therapy measures such as antibiotics, diet, and pain management were performed. Results The interventions were successful in both patients, resulting in rapid recourse of discomfort, abscess size, and sepsis. After controlling the consequences of complicated diverticulitis, both patients underwent laparoscopic sigmoid resection with primary anastomosis and without ileostomy during an inflammation-free interval. Conclusion Both cases demonstrate the advantages of EUS-PAD. A laparoscopic operation with primary anastomosis, lower perioperative risk, and without need of a protective ileostomy in early elective setting became possible by bridging the time until surgery by using EUS-PAD.
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Affiliation(s)
- Tina Goerl
- Klinik Für Allgemein- und Viszeralchirurgie, Bodden-kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
| | - Christoph Speck
- Klinik Für Innere Medizin II/Gastroenterologie, Bodden-kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
| | - Alexander Gehring
- Klinik Für Allgemein- und Viszeralchirurgie, Bodden-kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
| | - Reiko Wiessner
- Klinik Für Allgemein- und Viszeralchirurgie, Bodden-kliniken Ribnitz-Damgarten, Ribnitz-Damgarten, Germany
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4
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Soga K, Sai A, Kitae H. Efficacy of endoscopic ultrasound-guided pelvic abscess drainage for pelvic abscesses: A case series study. Arab J Gastroenterol 2023; 24:149-154. [PMID: 37689578 DOI: 10.1016/j.ajg.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/07/2023] [Accepted: 07/25/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND AND STUDY AIM This is a retrospective study to evaluate the safety and efficacy of endoscopic ultrasound-guided pelvic abscess drainage (EUS-PAD) in a single hospital setting. PATIENTS AND METHODS The referral criteria for EUS-PAD included patients with a pelvic abscess (PA) that was amenable for the procedure. A total of 14 patients with PA treated with EUS-PAD were included in this study. The mean patient age was 57.4 years, and male-to-female ratio was 7:7. Overall, there were six cases of appendiceal perforation, five of rectal cancer and one case each of the diverticular perforation, perianal abscess, and walled-off necrosis. RESULTS Overall, 100% of procedures were successful. Clinical success was achieved in 11 patients and they were discharged after EUS-PAD within 21.4 days on an average and the average duration of stent placement before removal was 27.0 days. Of all, six patients achieved complete improvement status where the cause was appendiceal perforation while two and one of the patients were recovered where the causes were post-curative operation for carcinoma and walled-off necrosis, respectively. Eight out of eleven patients who exhibited appendiceal perforation or underwent radical rectal cancer surgery were discharged after an average of 9.4 days post EUS-PAD. Although two patients showed temporary improvement, with perianal abscess and controlled rectal carcinoma, the PA worsened as the primary disease intensified. The PA drainage was ineffective in three patients where two of them had uncontrolled rectal cancer and one had diverticular perforation. CONCLUSION Conclusively, the EUS-PAD is not only a reliable, safe, and efficient alternative to surgical and percutaneous drainage but also a valuable procedure with a high success rate for patients with acute infections, such as those who have had an appendiceal perforation or curative surgery. Poor indications and contraindications for EUS-PAD include uncontrolled gastrointestinal perforation and direct tumor invasion.
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Affiliation(s)
- Koichi Soga
- Department of Gastroenterology, Omihachiman Community Medical Center, 1379 Tsuchida-cho, Omihachiman, Shiga 523-0082, Japan.
| | - Akinobu Sai
- Department of Gastroenterology, Omihachiman Community Medical Center, 1379 Tsuchida-cho, Omihachiman, Shiga 523-0082, Japan
| | - Hiroaki Kitae
- Department of Gastroenterology, Omihachiman Community Medical Center, 1379 Tsuchida-cho, Omihachiman, Shiga 523-0082, Japan
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5
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Peeters H, Simoens M, Lenz J. EUS-guided transrectal drainage of pelvic abscesses: a retrospective analysis of 17 patients. Acta Gastroenterol Belg 2023; 86:395-400. [PMID: 37814555 DOI: 10.51821/86.3.12029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background Pelvic abscess is a common complication of abdominal surgery or intestinal or gynecological diseases. Over the last decades, endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to percutaneous or surgical treatment of pelvic abscesses. Aim To evaluate safety and efficacy of EUS-guided transrectal pelvic abscess drainage in a single center. Methods From February 2017 to April 2023, all data on patients who were treated for pelvic abscesses by EUS-guided drainage in a single center, were retrospectively analyzed. Results A total of 17 patients were treated for pelvic abscesses by EUS-guided drainage. The procedure was technically successful and uneventful in all 17 patients (100%). Etiology of the abscess was postsurgical (n=5, 29%), secondary to medical illness (n=10, 59%) or gastrointestinal perforation (n=2, 12%). The abscess was multilocular in 5 patients (29%), the mean largest diameter was 76 mm (range 40-146 mm). Drainage was performed using 2 double pigtail stents, and in 1 patient an additional 10 Fr drainage catheter was deployed. Two patients (12%) required a second endoscopic intervention. Treatment success, defined by complete abscess resolution on follow-up CT scan along with symptom relief, was 100%. There was no need for surgical intervention. The median post-procedural hospital stay was 5 days. No recurrence was reported within a median time of follow-up of 39 months. Conclusion EUS-guided transrectal drainage of pelvic abscesses using double pigtail stents is safe and highly effective. This case series contributes to the cumulative evidence that, in expert hands, EUS-guided drainage should be considered as first-line approach for treatment of pelvic abscesses.
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Affiliation(s)
- H Peeters
- Department of Gastroenterology, University Hospitals Leuven, Belgium
| | - M Simoens
- Department of Gastroenterology, ZNA Jan Palfijn, Belgium
| | - J Lenz
- Department of Gastroenterology, ZNA Jan Palfijn, Belgium
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Koizumi K, Masuda S, Makazu M, Hirose H, Jinushi R, Shionoya K, Suno Y. Endoscopic ultrasound-guided transduodenal drainage using forward-viewing echoendoscope for appendiceal abscess. Endoscopy 2023; 55:E384-E385. [PMID: 36720268 PMCID: PMC9889167 DOI: 10.1055/a-1996-0657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Kazuya Koizumi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Sakue Masuda
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Makomo Makazu
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Haruto Hirose
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ryuhei Jinushi
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Kento Shionoya
- Gastroenterology Medicine Center, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Yuma Suno
- Department of General Surgery, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
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7
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Okuno N, Hara K, Mizuno N, Haba S, Kuwahara T, Kuraishi Y, Yanaidani T, Ishikawa S, Yasuda T, Yamada M, Fukui T. Endoscopic ultrasound-guided drainage for an abscess cavity. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nozomi Okuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shin Haba
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takamichi Kuwahara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasuhiro Kuraishi
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takafumi Yanaidani
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Sho Ishikawa
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Tsukasa Yasuda
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masanori Yamada
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Toshitaka Fukui
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
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8
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Okasha HH, Pawlak KM, Abou-elmagd A, El-Meligui A, Atalla H, Othman MO, Elenin SA, Alzamzamy A, Mahdy RE. Practical approach to linear endoscopic ultrasound examination of the rectum and anal canal. Endosc Int Open 2022; 10:E1417-E1426. [PMID: 36262505 PMCID: PMC9576334 DOI: 10.1055/a-1922-6500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
Standard endosonographic examination of the rectal area is usually performed with radial endoscopic ultrasound (EUS). However, in recent years, widespread availability of linear EUS for assessing various anatomical regions in the gastrointestinal tract has facilitated its use in the assessment of anorectal disorders. Currently, many rectal and anal diseases, including perianal abscesses, fistulae, polyps, and neoplastic lesions, can be well-visualized and evaluated with linear EUS. The aim of this review is to shed light on the anatomy and systematic examination of the anorectal region with linear EUS and clinical implications for different anorectal pathologies.
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Affiliation(s)
- Hussein Hassan Okasha
- Internal Medicine Department, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Katarzyna M. Pawlak
- Hospital of the Ministry of Interior and Administration, Endoscopy Unit, Department of Gastroenterology, Szczecin, Poland
| | | | - Ahmed El-Meligui
- Internal Medicine Department, Division of Gastroenterology, Kasr Al-Aini School of Medicine, Cairo University, Cairo, Egypt
| | - Hassan Atalla
- Internal Medicine Department, Hepatology and Gastroenterology Unit, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Sameh Abou Elenin
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo Egypt
| | - Ahmed Alzamzamy
- Department of Gastroenterology and Hepatology, Military Medical Academy, Cairo Egypt
| | - Reem Ezzat Mahdy
- Internal Medicine, gastroenterology and Hepatology Department, Assiut University, Assiut, Egypt
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9
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Pu X, Huang S, Zhang L, Zhang H, Xia H, Zeng X, Lü M, Peng Y, Ren J, Tang X. Endoscopic ultrasound-guided drainage of pelvic abscess: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2022; 16:993-1002. [PMID: 36170047 DOI: 10.1080/17474124.2022.2130247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES As an emerging minimally invasive technology, endoscopic ultrasound (EUS) has been reported to treat pelvic abscess instead of surgical or image-guided percutaneous drainage (PCD) under certain conditions. The aim of this study was to assess the efficacy and safety of EUS-guided drainage for patients with pelvic abscesses. METHODS We conducted a comprehensive literature search on PubMed, Embase, Cochrane Library, and Web of Science databases (inception-March 2022). The main outcomes were technical success, clinical success, and complications. Comprehensive meta-analysis software was used to calculate the pooled event rate. RESULTS Twelve studies containing 272 patients were included. These pelvic abscesses most frequently developed after abdominal and pelvic surgery (n = 180, 66.2%), inflammatory bowel disease (n = 32, 11.8%), and other inflammatory conditions. Respectively, the pooled technical and clinical success rate was 100% and 88.7% [95% confidence interval (CI): 83.8-92.2%, I2 = 1.0%, p < 0.001]. After excluding an individual study, the pooled rate of complications changed from 11.5% (95% CI: 7.4-17.4%, I2 = 38.8%, p < 0.001) to 8.2% (95% CI: 5.0-13.3%, I2 = 0, p < 0.001). CONCLUSIONS EUS-guided drainage of the pelvic abscess was feasible, effective, and safe. Further randomized-controlled studies with large-sample sizes were required in the future.
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Affiliation(s)
- Xinxin Pu
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Shu Huang
- Department of Gastroenterology, the People's Hospital of Lianshui, Huaian, Jiangsu province, China
| | - Lu Zhang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Han Zhang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Huifang Xia
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Xinyi Zeng
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Muhan Lü
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Yan Peng
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Jing Ren
- Department of Nursing, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Department of Endoscopic Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Xiaowei Tang
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, the Affliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
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10
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Li S, Sun Z, Di N, Liu Q, Wu F. Prostatic Abscess Combined With Spleen Abscess Due to Multi-Drug-Resistant Gram-Negative Bacilli: A Case Report and Literature Review. Am J Mens Health 2022; 16:15579883221108898. [PMID: 35801533 PMCID: PMC9274421 DOI: 10.1177/15579883221108898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The prostatic abscess is a rare complication of a bacterial infection of the prostate. Since the early use of potent antibiotics to treat urinary tract infections, the incidence of the prostatic abscess has declined significantly. In keeping with that, prostatic abscess combined with abscesses in the spleen or other distant organs become an extremely rare but fatal clinical condition. Here, we present a case of prostate and spleen abscess due to multi-drug-resistant gram-negative bacilli without obvious risk factors. The patient initially complained of high-grade fever and dysuria. After screening the source of infection by computed tomography (CT) scans, prostate and spleen abscesses were diagnosed. In addition, extended-spectrum beta-lactamase positive Escherichia coli was detected both in urine and blood culture. The patient was successfully treated by a transurethral resection of the prostate followed by splenic puncture and drainage, as well as intravenous administration of meropenem. Although the prostate abscess combined with spleen abscess was rare, the possibility of dissemination in remote tissues should be taken into consideration before the surgical treatment of prostatic abscesses. The concurrent drainage of multiple abscesses followed by intensive and sensitive antibiotics was safe and effective for indicated patients.
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Affiliation(s)
- Shun Li
- Department of Urology, The First Affiliated
Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital,
Jinan, P.R. China
| | - Zeqiang Sun
- Department of Urology, The First Affiliated
Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital,
Jinan, P.R. China
| | - Ning Di
- Outpatient Department of Infection, Shandong
Provincial Hospital Affiliated to Shandong First Medical University, Jinan, P.R. China
| | - Qingyong Liu
- Department of Urology, The First Affiliated
Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital,
Jinan, P.R. China
| | - Fei Wu
- Department of Urology, The First Affiliated
Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital,
Jinan, P.R. China
- Shandong Provincial Key Laboratory of
Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical
University and Shandong Academy of Medical Sciences, Jinan, P.R. China
- Qingyong Liu, Department of Urology, The First
Affiliated Hospital of Shandong First Medical University & Shandong Provincial
Qianfoshan Hospital, No. 16766 Jinshi Road, Jinan 250014, Shandong, P.R. China.
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11
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Naringrekar HV, Shahid H, Varghese C, Schlachterman A, Deshmukh SP, Roth CG. Extrapancreatic Advanced Endoscopic Interventions. Radiographics 2022; 42:379-396. [PMID: 35089818 DOI: 10.1148/rg.210087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As the field of interventional endoscopy advances, conditions that were once treated with surgery are increasingly being treated with advanced endoscopy. Endoscopy is now used for treatment of achalasia, bariatric procedures for obesity; resection of early-stage malignancies in the gastrointestinal tract; and placement of lumen-apposing metal stents in the treatment of biliary obstruction, gastric outlet obstruction, cholecystitis, and drainage of nonpancreatic-related fluid collections or abscesses. Knowledge of the novel terminology, procedural details, expected postintervention imaging findings, and potential complications is vital for radiologists because these procedures are rapidly becoming more mainstream in daily practice. These procedures include peroral endoscopic myotomy for the treatment of achalasia and other esophageal motility disorders; endoscopic sleeve gastroplasty and placement of an intragastric balloon for weight loss; endoscopic submucosal dissection in the resection of tumors of the gastrointestinal tract; and therapeutic endoscopic-guided procedures for the treatment of biliary obstruction, gastric outlet obstruction, acute cholecystitis, and drainage of nonpancreatically related fluid collections. Patients benefit from these minimally invasive procedures, with potential improvement in morbidity and mortality rates, decreased length of hospital stay, and decreased health care costs when compared with the surgical alternative. Complications of these procedures include leaks or perforations, infections or abscesses, fistulas, and occlusion and migration of stents. An invited commentary by Pisipati and Pannala is available online. ©RSNA, 2022.
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Affiliation(s)
- Haresh Vijay Naringrekar
- From the Department of Radiology (H.V.N., S.P.D., C.G.R.) and Department of Gastroenterology and Hepatology (A.S.), Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19123; Division of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (H.S.); and Department of Radiology, Westchester Medical Center, Valhalla, NY (C.V.)
| | - Haroon Shahid
- From the Department of Radiology (H.V.N., S.P.D., C.G.R.) and Department of Gastroenterology and Hepatology (A.S.), Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19123; Division of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (H.S.); and Department of Radiology, Westchester Medical Center, Valhalla, NY (C.V.)
| | - Cyril Varghese
- From the Department of Radiology (H.V.N., S.P.D., C.G.R.) and Department of Gastroenterology and Hepatology (A.S.), Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19123; Division of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (H.S.); and Department of Radiology, Westchester Medical Center, Valhalla, NY (C.V.)
| | - Alex Schlachterman
- From the Department of Radiology (H.V.N., S.P.D., C.G.R.) and Department of Gastroenterology and Hepatology (A.S.), Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19123; Division of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (H.S.); and Department of Radiology, Westchester Medical Center, Valhalla, NY (C.V.)
| | - Sandeep P Deshmukh
- From the Department of Radiology (H.V.N., S.P.D., C.G.R.) and Department of Gastroenterology and Hepatology (A.S.), Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19123; Division of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (H.S.); and Department of Radiology, Westchester Medical Center, Valhalla, NY (C.V.)
| | - Christopher G Roth
- From the Department of Radiology (H.V.N., S.P.D., C.G.R.) and Department of Gastroenterology and Hepatology (A.S.), Thomas Jefferson University Hospital, 132 S 10th St, Philadelphia, PA 19123; Division of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ (H.S.); and Department of Radiology, Westchester Medical Center, Valhalla, NY (C.V.)
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12
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Guingand M, Gasmi M, Serrero M, Barthet M, Gonzalez JM. Endoscopic ultra-sound (EUS) guided management of symptomatic pelvic collections: puncture-aspiration or drainage? Results from mono-centric retrospective experience with therapeutic algorithm. Scand J Gastroenterol 2022; 57:112-118. [PMID: 34565279 DOI: 10.1080/00365521.2021.1979093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pelvic collections may occur after surgery or in medical diseases. EUS transmural (TM) treatment has been shown as highly effective and safe, becoming an alternative to surgery or radiology. We aimed to assess the results of EUS management of pelvic collections. METHODS Retrospective, single-center observational study conducted between 2004 and 2018. Patients with symptomatic collections treated by EUS-TM approach were enrolled. The procedures were performed with a therapeutic EUS-scope, following two possible options: puncture-aspiration-injection of antibiotics PAIA (group 1) or EUS-drainage by plastic double pigtail stents (DPS) with an ano-cavitary drain (ACD) or lumen-apposing metal Stent (LAMS) (group 2). The main objective was to assess the clinical effectiveness based on symptoms and collection resolution. RESULTS Seventy-three patients were included. Mean age was 42.5 years [12-87]. 30 patients in group 1 (41%) underwent PAIA and 43 in group 2 (59%) underwent DPS ± ACD in 41 patients (95%) and LAMS in 2. The collection was postoperative in 58%. The mean size was 48.9 mm [8-120], 33 +/- 17 mm in group 1, compared to 67 ± 21 mm in group 2 (p < .0001). All the procedures were technically successful. Overall clinical success was 96% (93% in group 1 (28/30), 98% (42/43) in group 2). Failures occurred in 2 post sigmoiditis abscesses and 1 ileo-colic Crohn's disease. No adverse event was reported. During the median follow-up of 7.5 years [4.4-8.9], no patient had recurrence. CONCLUSIONS EUS-TM with either PAIA or drainage depending on the collection size is confirmed to be highly effective and safe.
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Affiliation(s)
- Marine Guingand
- Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Mohamed Gasmi
- Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Mélanie Serrero
- Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
| | - Marc Barthet
- Aix-Marseille Université, AP-HM, Hôpital Nord, Marseille, France
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Ouyang BW, Liu TW, Fu ZL, Li Y, Zhang B. Endoscopic ultrasound-guided pelvic abscess drainage: a report of 2 cases and literature review. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 59:1053-1058. [PMID: 34638153 DOI: 10.1055/a-1581-8777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Drainage is essential for source control of the infection in a pelvic abscess. The purpose of this study was to report 2 cases of endoscopic ultrasound (EUS)-guided drainage of the pelvic abscess and review the literature of different modalities of EUS-guided drainage of pelvic abscess. CASE PRESENTATION A 60-year-old male developed a pelvic abscess 1 month after laparoscopic complete tumor resection. An abdominal CT showed a mass shadow (about 7.1 cm × 5.1 cm) in the right pelvic region. Another case was an 85-year-old male who developed a pelvic abscess 3 days after recurrent tumor resection of multiple organs. The CT showed pelvic effusion and gas accumulation (approximately 6.5 cm × 4.2 cm), and the intestinal tube above the small intestinal anastomosis was dilated with effusion. A 19G-A puncture needle was used to puncture the abscess. An 8-mm cylindrical balloon was inserted, followed by a 10 Fr-3 cm double pigtail stent and an 8.5 Fr drainage tube. After EUS-guided drainage of pelvic abscess, the symptoms disappeared without recurrence. CONCLUSIONS EUS-guided drainage is an effective and safe method for treating pelvic abscesses as long as the drainage modality is appropriately selected based on the etiology, size, and mucus viscosity of the abscess.
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Affiliation(s)
- Bo-Wen Ouyang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tian-Wen Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zao-Li Fu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ye Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Beiping Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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14
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Soga K, Mukai H, Akamatsu N. Effective procedure for endoscopic ultrasound-guided prostate abscess aspiration drainage and saline irrigation. Dig Endosc 2021; 33:e23-e24. [PMID: 33368690 DOI: 10.1111/den.13894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Koichi Soga
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, Japan
| | - Hiroki Mukai
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, Japan
| | - Naoaki Akamatsu
- Department of Gastroenterology, Omihachiman Community Medical Center, Shiga, Japan
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15
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Dhindsa BS, Naga Y, Saghir SM, Dhaliwal A, Ramai D, Cross C, Singh S, Bhat I, Adler DG. EUS-guided pelvic drainage: A systematic review and meta-analysis. Endosc Ultrasound 2021; 10:185-190. [PMID: 33463556 PMCID: PMC8248303 DOI: 10.4103/eus.eus_71_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background and Objectives: EUS-guided pelvic abscess drainage (EUS-PAD) is a procedure that utilizes an echoendoscope to visualize an area of interest for needle insertion and placement of a stent, catheter, or both for drainage of the target abscess. The aim of this study was to perform a systematic review and meta-analysis for the safety and efficacy of EUS-PAD. Materials and Methods: We conducted a comprehensive search of several databases and conference proceedings including PubMed, EMBASE, Google Scholar, MEDLINE, SCOPUS, and Web of Science databases (earliest inception to February 2020). The primary outcomes for this study were the technical and clinical success of EUS-PAD. The secondary outcomes assessed for this study were adverse events of the procedure and subgroup analysis of individual adverse events. Results: Eight studies with a total of 135 patients combined were included in our analysis. The rate of technical success was 100% and the calculated pooled rate of clinical success was 92% (95% confidence interval [CI]: 87%, 98%; P = 0.31; I2 = 15%). The calculated pooled rate of adverse events was 9.4% (±17.9%), with stent migration (5.5 ± 18.06%) being the most common adverse event. Conclusion: EUS-PAD offers a viable alternative that can minimize the need for surgical intervention in the drainage of pelvic abscesses. EUS-PAD has also demonstrated long-term clinical success with an acceptable rate of complications.
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Affiliation(s)
- Banreet Singh Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, USA
| | - Yassin Naga
- Department of Internal Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Syed Mohsin Saghir
- Department of Internal Medicine, University of Nevada, Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology and Hepatology, Moffitt Cancer Center, Tampa, FL, USA
| | - Daryl Ramai
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Chad Cross
- Department of Biostatistics and Epidemiology, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Shailender Singh
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, USA
| | - Ishfaq Bhat
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, USA
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah, School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah, USA
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Chin YK, Asokkumar R. Endoscopic ultrasound-guided drainage of difficult-to-access liver abscesses. SAGE Open Med 2020; 8:2050312120921273. [PMID: 32435490 PMCID: PMC7222655 DOI: 10.1177/2050312120921273] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/02/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Antibiotic therapy and percutaneous drainage have been the first-line treatments for liver abscesses. However, percutaneous drainage of abscesses may be challenging in difficult-to-access locations such as the caudate lobe. The aim of this review was to determine the indications, technical feasibility and efficacy of endoscopic ultrasound-guided drainage of difficult-to-access liver abscesses. METHODS A literature review of original articles, abstracts, case series and case reports describing endoscopic ultrasound-guided liver abscess drainage was performed. The indications, techniques and complications associated with endoscopic ultrasound-guided drainage were reviewed. RESULTS A total of 15 studies were identified. The main indications were failed antibiotic therapy and difficulty in gaining percutaneous access. The technique involved identification and puncturing of an abscess under endoscopic ultrasound guidance followed by placement of a prosthesis via a guide wire. The technique was 97.5% successful with no major complications reported. CONCLUSION Endoscopic ultrasound-guided drainage was feasible and safe and allowed complete drainage of liver abscesses not accessible by percutaneous drainage.
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Affiliation(s)
- Yung Ka Chin
- Department of Gastroenterology and Hepatology, Academia, Singapore General Hospital, Singapore
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Academia, Singapore General Hospital, Singapore
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17
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Gkegkes ID, Stamatiadis AP. Anal Pain of an Unusual Cause: Role of Endoanal Ultrasound. J Med Ultrasound 2019; 27:107-109. [PMID: 31316223 PMCID: PMC6607880 DOI: 10.4103/jmu.jmu_90_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/18/2018] [Indexed: 11/18/2022] Open
Abstract
Anal pain is among the most frequent complaints referred in coloproctology clinic. Nevertheless, this symptom may have a great variety of etiopathogenetic causes. This is the first report that highlights the presence of a rare cause of anal pain, originated by ingested seeds. A 65-year-old male had a 4-day history of fever, anal pain, and discharge. A three-dimensional endoanal ultrasound revealed two perianal abscess cavities with central hyperechogenic areas, in the absence of acoustic shadow. The patient underwent examination under epidural anesthesia, where the two cavities were drained endoanally. Two cereal grains (linseed/sunflower seed) were found during the drainage of the abscess. The utilization of endoanal ultrasound in the investigation of perianal pain is a valuable option. In addition, apart from the size and the exact dimensions of abscesses, endoanal ultrasound also permits the clarification even the most remote etiopathogenetic causes of anal pain.
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Affiliation(s)
- Ioannis D Gkegkes
- Athens Colorectal Laboratory, Athens, Greece.,Department of Surgery, General Hospital of Attica "KAT", Athens, Greece
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18
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Zator Z, Klinge M, Schraut W, Tsung A, Khalid A. One step endoscopic ultrasound guided management of pelvic abscesses: a case series. Therap Adv Gastroenterol 2018; 11:1756284818785574. [PMID: 30034531 PMCID: PMC6048614 DOI: 10.1177/1756284818785574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 05/29/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Endoscopic management of pelvic abscesses not amenable to percutaneous drainage has been described. The technique employs endoscopic ultrasound (EUS)-guided placement of stents or drains, which may require multiple procedures, is cumbersome and uncomfortable for the patient. We describe the successful management of these abscesses in a single step involving EUS-guided lavage and instillation of antibiotics. METHODS Six consecutive patients with seven symptomatic pelvic abscesses not amenable to percutaneous drainage were referred for EUS-guided drainage. The abscesses were aspirated with a 19-gauge needle under EUS guidance and serially lavaged with an equal aspirate to instillation volume of sterile saline until cleared of pus. The residual cavity was then instilled with gentamicin 40 mg/ml. Patients were followed clinically and radiographically with repeat computed tomography or magnetic resonance imaging. RESULTS All patients had rapid resolution of symptoms. The abscesses disappeared completely in four patients. One patient with recurrent diverticulitis and abscess had marked decrease in abscess size and inflammation to permit planned sigmoid resection. One patient with Crohn's disease had clinical improvement and marked decrease in abscess size, permitting outpatient management of Crohn's disease. CONCLUSIONS EUS-guided lavage and instillation of antibiotics is a simple, one-step approach in the management of pelvic abscesses and may obviate the need for prolonged drain management and repeat procedures in select cases.
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Affiliation(s)
- Zachary Zator
- Department of Medicine, The University of
Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Matthew Klinge
- Department of Medicine, The University of
Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Wolfgang Schraut
- Department of Surgery, VA Pittsburgh HealthCare
System, Pittsburgh, PA, USA
| | - Allan Tsung
- Department of Surgery, The University of
Pittsburgh Medical Center, Pittsburgh, PA, USA
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19
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Meylemans DVG, Oostenbrug LE, Bakker CM, Sosef MN, Stoot JHMB, Belgers HJ. Endoscopic ultrasound guided versus surgical transrectal drainage of pelvic abscesses. Acta Chir Belg 2018; 118:181-187. [PMID: 29207920 DOI: 10.1080/00015458.2017.1411549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pelvic abscesses are common but only small case series reporting outcome of either endoscopic ultrasound (EUS) guided or surgical transrectal drainage have been reported. METHODS We performed a retrospective consecutive cohort study, assessing effectivity and safety of EUS guided or surgical transrectal drainage of previously untreated pelvic abscesses from all causes, diagnosed using CT scan between 09/2010 and 06/2014 in a Dutch teaching hospital. RESULTS Forty-six patients with comparable demographics, apart from stoma presence (p = .016), were included. The success rate after a single intervention was 83% in the EUS guided compared to 48% in the surgical transrectal drainage group (p = .013). However, the mean duration of drainage was threefold in the EUS group [42 versus 13 days (p = .001)]. The length of stay in hospital was similar for both EUS and surgical group [24 versus 20 days (p = .56)] as was abscess resolution during follow-up [78% versus 74%]. We recorded a total of 12 anastomotic leaks [3 versus 9]. In the occurrence of leakage, only one stoma was finally closed in each group. CONCLUSION EUS guided and surgical transrectal drainage of pelvic abscesses from any cause are safe, nonetheless EUS guided drainage(if feasible) seems more effective after a single treatment, with high overall cure rates.
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Affiliation(s)
- D. V. G. Meylemans
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - L. E. Oostenbrug
- Department of Internal Medicine and Gastroenterology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - C. M. Bakker
- Department of Internal Medicine and Gastroenterology, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - M. N. Sosef
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - J. H. M. B. Stoot
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
| | - H. J. Belgers
- Department of Surgery, Zuyderland Medisch Centrum, Heerlen, The Netherlands
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20
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Mudireddy PR, Sethi A, Siddiqui AA, Adler DG, Nieto J, Khara H, Trindade A, Ho S, Benias PC, Draganov PV, Yang D, Mok S, Confer B, Diehl DL. EUS-guided drainage of postsurgical fluid collections using lumen-apposing metal stents: a multicenter study. Gastrointest Endosc 2018; 87:1256-1262. [PMID: 28843581 DOI: 10.1016/j.gie.2017.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 08/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Postsurgical fluid collections (PSFCs) are traditionally drained either percutaneously or surgically. Endoscopic drainage offers several advantages compared with either percutaneous or surgical approaches, including avoiding repeat surgery or the need to have a percutaneous drain in place for weeks. There are very little data regarding the use of lumen-apposing metal stents (LAMSs) in the drainage of PSFCs. We aim to study the technical and clinical success and adverse events (AEs) of using LAMSs in the drainage of PSFCs. METHODS Collaborators from 8 centers retrospectively reviewed their endoscopic databases to find procedures using LAMSs for drainage of PSFCs. Technical success (successful placement of LAMSs into the fluid collection), clinical success (complete resolution of the fluid collection on repeat imaging or endoscopy), and intraprocedure and postprocedure AEs were measured. RESULTS Forty-seven patients were identified with PSFCs after various surgeries. Thirteen patients had failed previous percutaneous or surgical drainage attempts. Fluid collections averaged 78.6 mm (range, 47-150 mm) in size. The most common site of stent placement was transgastric, followed by rectum and duodenum. Technical success rate was 93.6% and clinical success rate 89.3%. The intraprocedural AE rate was 4.25% and postprocedural AE rate 6.4%. There was 1 death unrelated to the procedure. CONCLUSIONS The use of LAMSs to drain PSFCs has a high technical and clinical success rate with low AEs. For collections that are favorably located adjacent to the stomach, duodenum, or rectum, LAMS placement is a viable alternative to repeat surgery or percutaneous drainage.
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Affiliation(s)
- Prashant R Mudireddy
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Amrita Sethi
- Department of Gastroenterology, Columbia University Medical Center, New York, New York, USA
| | - Ali A Siddiqui
- Department of Gastroenterology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jose Nieto
- Department of Gastroenterology, Borland-Groover Clinic, Jacksonville, Florida, USA
| | - Harshit Khara
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Arvind Trindade
- Department of Gastroenterology, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Sammy Ho
- Department of Gastroenterology, Montefiore Medical Center, Bronx, New York, USA
| | - Petros C Benias
- Department of Gastroenterology, Long Island Jewish Medical Center, Northwell Health System, New Hyde Park, New York, USA
| | - Peter V Draganov
- Department of Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Dennis Yang
- Department of Gastroenterology, University of Florida, Gainesville, Florida, USA
| | - Shaffer Mok
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Bradley Confer
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L Diehl
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
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21
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Donatelli G, Fuks D, Cereatti F, Pourcher G, Perniceni T, Dumont JL, Tuszynski T, Vergeau BM, Meduri B, Gayet B. Endoscopic transmural management of abdominal fluid collection following gastrointestinal, bariatric, and hepato-bilio-pancreatic surgery. Surg Endosc 2017; 32:2281-2287. [DOI: 10.1007/s00464-017-5922-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 10/08/2017] [Indexed: 12/21/2022]
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22
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Mahadev S, Lee DS. Endoscopic Ultrasound-Guided Drainage of Pelvic Fluid Collections. Gastrointest Endosc Clin N Am 2017; 27:727-739. [PMID: 28918808 DOI: 10.1016/j.giec.2017.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pelvic fluid collections can be challenging and often inaccessible because of their location and close proximity to adjacent organs and spine. This causes an increased risk for morbidity and poor outcomes. Recent advances in endoscopic ultrasound and therapeutic devices provide an effective, safe, and minimally invasive option to surgery or interventional radiology. These devices offer a relatively pain-free method that has shown good outcomes with minimal risk in recent case series, and has increasingly become the first-line treatment of choice. This article summarizes the current literature and the technique and considerations for successful drainage of these collections.
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Affiliation(s)
- SriHari Mahadev
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, 630 West 168th Street, P&S 3-401, New York, NY 10032, USA
| | - David S Lee
- Division of Digestive and Liver Diseases, Department of Medicine, Columbia University Medical Center, 630 West 168th Street, P&S 3-401, New York, NY 10032, USA.
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Bruno MJ. Interventional endoscopic ultrasonography: Where are we headed? Dig Endosc 2017; 29:503-511. [PMID: 28181708 DOI: 10.1111/den.12842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/06/2017] [Indexed: 02/08/2023]
Abstract
Endoscopic ultrasonography (EUS) is an essential endoscopic tool within the diagnostic and therapeutic armamentarium of gastrointestinal and hepatic diseases. EUS-guided tissue acquisition will develop towards facilitating personalized treatment by obtaining large representative tissue specimens for elaborate immunohistochemical and biomolecular typing of the tumor. Intratumoral or intravascular delivery of drugs potentially offers many advantages over systemic injection. Intratumoral application of radiofrequency ablation and photodynamic therapy show promise but need to be explored further. Appositioning and connecting luminal structures within the gastrointestinal tract using fully covered expandable lumen-apposing stents will expand its indication far beyond the drainage of (infected) fluid collections and EUS-guided gastrojejunostomy is a particularly exciting development that could have significant impact on the management of gastric outlet obstruction.
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Affiliation(s)
- Marco J Bruno
- Department of Gastroenterology & Hepatology, Erasmus Medical Centre, University Medical Center Rotterdam, Rotterdam, The Netherlands
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25
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Choi EK, Kim JH, Jeong SU, Na SY, Boo SJ, Kim HU, Song BC. Endoscopic Ultrasound-Guided Perirectal Abscess Drainage without Drainage Catheter: A Case Series. Clin Endosc 2017; 50:297-300. [PMID: 28395397 PMCID: PMC5475510 DOI: 10.5946/ce.2016.123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/30/2017] [Accepted: 02/11/2017] [Indexed: 11/17/2022] Open
Abstract
A perirectal abscess is a relatively common disease entity that occurs as a postsurgical complication or as a result of various medical conditions. Endoscopic ultrasound (EUS)-guided drainage was recently described as a promising alternative treatment. Previous reports have recommended placement of a drainage catheter through the anus for irrigation, which is inconvenient to the patient and carries a risk of accidental dislodgement. We report four cases of perirectal abscess that were successfully treated with only one or two 7 F double pigtail plastic stent placements and without a drainage catheter for irrigation.
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Affiliation(s)
- Eun Kwang Choi
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ji Hyun Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seung Uk Jeong
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Soo-Young Na
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Byung-Cheol Song
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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26
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Manvar A, Karia K, Ho S. Endoscopic ultrasound-guided drainage of pelvic abscesses with lumen-apposing metal stents. Endosc Ultrasound 2017; 6:217-218. [PMID: 28820143 PMCID: PMC5579905 DOI: 10.4103/eus.eus_46_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Amar Manvar
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kunal Karia
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sammy Ho
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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27
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Endoscopic Ultrasound-Guided Drainage without Fluoroscopic Guidance for Extraluminal Complicated Cysts. Gastroenterol Res Pract 2016; 2016:1249064. [PMID: 27313606 PMCID: PMC4904102 DOI: 10.1155/2016/1249064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/14/2016] [Accepted: 05/09/2016] [Indexed: 12/17/2022] Open
Abstract
Background. Endoscopic ultrasound- (EUS-) guided drainage is generally performed under fluoroscopic guidance. However, improvements in endoscopic and EUS techniques and experience have led to questions regarding the usefulness of fluoroscopy. This study aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage of extraluminal complicated cysts without fluoroscopic guidance. Methods. Patients who had undergone nonfluoroscopic EUS-guided drainage of extraluminal complicated cysts were enrolled. Drainage was performed via a transgastric, transduodenal, or transrectal approach. Single or double 7 Fr double pigtail stents were inserted. Results. Seventeen procedures were performed in 15 patients in peripancreatic fluid collections (n = 13) and pelvic abscesses (n = 4). The median lesion size was 7.1 cm (range: 2.8-13.0 cm), and the mean time spent per procedure was 26.2 ± 9.8 minutes (range: 16-50 minutes). Endoscopic drainage was successful in 16 of 17 (94.1%) procedures. There were no complications. All patients experienced symptomatic improvement and revealed partial to complete resolution according to follow-up computed tomography findings. Two patients developed recurrent cysts that were drained during repeat procedures, with eventual complete resolution. Conclusion. EUS-guided drainage without fluoroscopic guidance is a technically feasible, safe, and effective procedure for the treatment of extraluminal complicated cysts.
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28
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Ratone JP, Bertrand J, Godat S, Bernard JP, Heyries L. Transrectal drainage of pelvic collections: Experience of a single center. Endosc Ultrasound 2016; 5:108-10. [PMID: 27080609 PMCID: PMC4850789 DOI: 10.4103/2303-9027.180474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pelvic abscesses are a well-known complication of intestinal diseases or abdominal surgery. We report our case series concerning transrectal drainage by endoscopic ultrasound (EUS). METHODS Between January 2010 and august 2014, seven patients received transrectal drainage by endoscopic ultrasound (EUS) were selected and analyzed. RESULTS Two pigtails was positioned under fluoroscopic and EUS control. The success rate was 100% and complication rate was 0%. The median time of hospitalization was 10 days [range 4-25]. CONCLUSIONS The technique appears to be safe and feasible in all etiologies. In our experience, we can considerate transrectal drainage by EUS like a first-line technique in experienced hands.
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Percutaneous transgluteal drainage of pelvic abscesses in interventional radiology: A safe alternative to surgery. J Visc Surg 2016; 153:3-7. [DOI: 10.1016/j.jviscsurg.2015.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dabizzi E, De Ceglie A, Kyanam Kabir Baig KR, Baron TH, Conio M, Wallace MB. Endoscopic "rescue" treatment for gastrointestinal perforations, anastomotic dehiscence and fistula. Clin Res Hepatol Gastroenterol 2016. [PMID: 26209869 DOI: 10.1016/j.clinre.2015.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Luminal perforations and anastomotic leaks of the gastrointestinal tract are life-threatening events with high morbidity and mortality. Early recognition and prompt therapy is essential for a favourable outcome. Surgery has long been considered the "gold standard" approach for these conditions; however it is associated with high re-intervention morbidity and mortality. The recent development of endoscopic techniques and devices to manage perforations, leaks and fistulae has made non-surgical treatment an attractive and reasonable alternative approach. Although endoscopic therapy is widely accepted, comparative data of the different techniques are still lacking. In this review we describe, benefits and limitations of the current options in the management of patients with perforations and leaks, in order to improve outcomes.
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Affiliation(s)
- Emanuele Dabizzi
- Gastroenterology and Digestive Endoscopy Division, Vita-Salute San Raffaele Univeristy, San Raffaele Scientific Institute, Milan, Italy.
| | - Antonella De Ceglie
- Gastroenterology and Digestive Endoscopy Unit, "G. Borea" Hospital, San Remo, Italy
| | | | - Todd H Baron
- Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Massimo Conio
- Gastroenterology and Digestive Endoscopy Unit, "G. Borea" Hospital, San Remo, Italy
| | - Michael B Wallace
- Division of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, Florida, USA
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EUS-FNA can be an effective procedure for the transesophageal drainage of a patient with intra-peritoneal abscess. Clin J Gastroenterol 2015. [PMID: 26215115 DOI: 10.1007/s12328-015-0588-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is considered to be a highly beneficial and safe diagnostic tool. EUS-FNA now has a greater clinical impact because the technique is currently being applied for therapeutic as well as diagnostic purposes. The treatment of intra-peritoneal abscess after peptic ulcer perforation has traditionally been by surgery, especially when percutaneous abscess drainage is unfeasible. We report that less invasive drainage using EUS-FNA was useful in treating a patient with an abscess who had no other option but to select surgical treatment.
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Sharma V, Rana SS, Bhasin DK. Endoscopic ultrasound guided interventional procedures. World J Gastrointest Endosc 2015; 7:628-42. [PMID: 26078831 PMCID: PMC4461937 DOI: 10.4253/wjge.v7.i6.628] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/24/2015] [Accepted: 02/09/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the field of gastrointestinal endoscopy. EUS provides access to many organs and lesions which are in proximity to the gastrointestinal tract and thus giving an opportunity to target them for therapeutic and diagnostic purposes. This modality also provides a real time opportunity to target the required area while avoiding adjacent vascular and other structures. Therapeutic EUS has found role in management of pancreatic fluid collections, biliary and pancreatic duct drainage in cases of failed endoscopic retrograde cholangiopancreatography, drainage of gallbladder, celiac plexus neurolysis/blockage, drainage of mediastinal and intra-abdominal abscesses and collections and in targeted cancer chemotherapy and radiotherapy. Infact, therapeutic EUS has emerged as the therapy of choice for management of pancreatic pseudocysts and recent innovations like fully covered removable metallic stents have improved results in patients with organised necrosis. Similarly, EUS guided drainage of biliary tract and pancreatic duct helps drainage of these systems in patients with failed cannulation, inaccessible papilla as with duodenal/gastric obstruction or surgically altered anatomy. EUS guided gall bladder drainage is a useful emergent procedure in patients with acute cholecystitis who are not fit for surgery. EUS guided celiac plexus neurolysis and blockage is more effective and less morbid vis-à-vis the percutaneous technique. The field of interventional EUS is rapidly advancing and many more interventions are being continuously added. This review focuses on the current status of evidence vis-à-vis the established indications of therapeutic EUS.
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Infected retroperitoneal pelvic necrosis in severe acute pancreatitis: how can we manage it? Eur J Gastroenterol Hepatol 2015; 27:449-54. [PMID: 25874520 DOI: 10.1097/meg.0000000000000305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Retroperitoneal necrosis in the pelvic cavity is a rare complication of severe acute pancreatitis (SAP), mainly developing in critically ill patients. Because of its particular anatomy, it is difficult to perform drainage or surgery. We hypothesized that computed tomography (CT)-guided drainage is an effective approach for the infected retroperitoneal necrosis. The aim of this study is to evaluate the safety and effectiveness of CT-guided transgluteal drainage in SAP patients with infected retroperitoneal pelvic necrosis. MATERIALS AND METHODS Twelve SAP patients with infected retroperitoneal pelvic necrosis underwent CT-guided transgluteal drainage with a 12-month follow-up. The safety and effectiveness of drainage were measured by the complication rate and the rate of clinical success. RESULTS All the 12 patients underwent a successful drainage under the guidance of CT and their clinical symptoms disappeared within 48 h. One patient died of another serious complication of SAP and in the remaining 11 patients, complete resolution was achieved without major complications. The mean catheter indwelling time was 21.5 days. Repeated CT during the follow-up period showed no recurrence in the remaining 11 patients. CONCLUSION Transgluteal drainage under the guidance of CT was found to be an effective and appropriate approach for infected pelvic necrosis in SAP patients.
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Abstract
Over the last 2 decades, endoscopic ultrasound (EUS) has evolved from a noninvasive diagnostic tool to a combined diagnostic and therapeutic modality. The use of EUS complementary to endoscopic retrograde cholangiopancreatography (ERCP) has made possible biliary and pancreatic drainage in situations where conventional ERCP is unsuccessful or unlikely to be feasible. The degree of proximity to the pancreas achieved during the procedure has enabled therapeutic interventions such as drainage of peripancreatic fluid collections, pancreatic cyst ablation, and pancreatic cancer therapy. Real-time visualization of flow in adjacent blood vessels using Doppler ultrasound has allowed endovascular therapy for ablation of gastric varices and feeding vessels. Furthermore, the role of EUS is evolving in a multitude of applications such as bilioenteric and enteroenteric anastomosis in a minimally invasive manner, potentially reducing the need for surgery. This article reviews the role of EUS as an alternative to surgery in selective situations and provides an overview of future directions and evolving uses of EUS.
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Widmer JL, Michel K. Endoscopic Ultrasound-Guided Treatment beyond Drainage: Hemostasis, Anastomosis, and Others. Clin Endosc 2014; 47:432-9. [PMID: 25325004 PMCID: PMC4198561 DOI: 10.5946/ce.2014.47.5.432] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/20/2014] [Indexed: 02/06/2023] Open
Abstract
Since the introduction of endoscopic ultrasound (EUS) in the 1990s, it has evolved from a primarily diagnostic modality into an instrument that can be used in various therapeutic interventions. EUS-guided fine-needle injection was initially described for celiac plexus neurolysis. By using the fundamentals of this method, drainage techniques emerged for the biliary and pancreatic ducts, fluid collections, and abscesses. More recently, EUS has been used for ablative techniques and injection therapies for patients with for gastrointestinal malignancies. As the search for minimally invasive techniques continued, EUS-guided hemostasis methods have also been described. The technical advances in EUS-guided therapies may appear to be limitless; however, in many instances, these procedures have been described only in small case series. More data are required to determine the efficacy and safety of these techniques, and new accessories will be needed to facilitate their implementation into practice.
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Affiliation(s)
- Jessica L Widmer
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
| | - Kahaleh Michel
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, USA
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Holt B, Varadarajulu S. Endoscopic ultrasound-guided pelvic abscess drainage (with video). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 22:12-5. [PMID: 25159523 DOI: 10.1002/jhbp.150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pelvic abscesses present a serious and challenging management problem. Endoscopic ultrasound (EUS)-guided drainage provides a safe and effective minimally invasive treatment option. The likelihood of a successful outcome is dependent on appropriate patient selection, drainage technique and postoperative management. This review outlines the evidence behind and procedural steps required for EUS-guided pelvic abscess drainage.
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Affiliation(s)
- Bronte Holt
- Center for Interventional Endoscopy, Florida Hospital, 601 East Rollins Street, Orlando, FL, 32803, USA
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Sordo-Mejia R, Gaertner WB. Multidisciplinary and evidence-based management of fistulizing perianal Crohn's disease. World J Gastrointest Pathophysiol 2014; 5:239-51. [PMID: 25133026 PMCID: PMC4133523 DOI: 10.4291/wjgp.v5.i3.239] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 05/07/2014] [Accepted: 05/28/2014] [Indexed: 02/06/2023] Open
Abstract
Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial to improve outcomes.
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Fabbri C, Luigiano C, Lisotti A, Cennamo V, Virgilio C, Caletti G, Fusaroli P. Endoscopic ultrasound-guided treatments: are we getting evidence based--a systematic review. World J Gastroenterol 2014; 20:8424-48. [PMID: 25024600 PMCID: PMC4093695 DOI: 10.3748/wjg.v20.i26.8424] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/30/2014] [Accepted: 03/12/2014] [Indexed: 02/07/2023] Open
Abstract
The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound (EUS)-guided treatments. These include EUS-guided drainage of pancreatic fluid collections, EUS-guided necrosectomy, EUS-guided cholangiography and biliary drainage, EUS-guided pancreatography and pancreatic duct drainage, EUS-guided gallbladder drainage, EUS-guided drainage of abdominal and pelvic fluid collections, EUS-guided celiac plexus block and celiac plexus neurolysis, EUS-guided pancreatic cyst ablation, EUS-guided vascular interventions, EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and brachytherapy. However these procedures are technically challenging and require expertise in both EUS and interventional endoscopy, such as endoscopic retrograde cholangiopancreatography and gastrointestinal stenting. We undertook a systematic review to record the entire body of literature accumulated over the past 2 decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles, based on the classification of studies according to levels of evidence, in order to assess the scientific progress made in this field.
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Abstract
OPINION STATEMENT Endoscopic ultrasound (EUS) is not only a diagnostic tool but also an interventional and therapeutic procedure. Indeed, in addition to tissue acquisition, it can also drain fluid collections adjacent to the gastrointestinal tract, provide access to biliary and pancreatic ducts, biliary, pancreatic, and gallbladder drainage, pancreatic cyst ablation, and, finally, provide anti-tumoral treatments and interventional vascular procedures. Although several improvements have been made in the last decade, the full potential of interventional EUS is yet to be completely explored. Future areas of research are the development of dedicated tools and accessories, the standardization of the interventional procedures, and the widening of the use of EUS, while increasing the expertise worldwide. In addition, more data, based on well-performed, possibly randomized clinical trials, are needed to accurately determine the risks and long-term outcomes of these interventions. We firmly believe that interventional EUS can play a pivotal role in anti-tumor treatments, by the fine-needle injection of anti-tumoral agents, tumor ablation, and assisting radiation treatment with gold fiducial placement and the implantation of intralesional seeds. The goal of the near future will be to offer targeted therapy and monitoring of tumor treatment response in a more biologically driven manner than has been available in the past. Interventional EUS will be an essential part of the multidisciplinary approach to cancer treatment.
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40
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Interventional endoscopic ultrasonography: an overview of safety and complications. Surg Endosc 2013; 28:712-34. [PMID: 24196551 DOI: 10.1007/s00464-013-3260-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Accepted: 09/27/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND In recent years, endoscopic ultrasonography (EUS)-guided techniques have been developed as alternatives to surgical, radiologic, or conventional endoscopic approaches for the treatment or palliation of several digestive diseases. The use of EUS guidance allows the therapeutic area to be targeting more precisely, with a possible clinical benefit and less morbidity. Nevertheless, the risks persist and must be taken into consideration. This review gives an overview of the complications observed with the most established procedures of therapeutic EUS. METHODS The PubMed and Embase databases were used to search English language articles on interventional EUS. The studies considered for inclusion were those reporting on complications of EUS-guided celiac plexus block (EUS-CPB), EUS-guided celiac plexus neurolysis (EUS-CPN), drainage of fluid pancreatic and pelvic collections, and EUS-guided biliary and pancreatic drainage (EUS-BD and EUS-PD). Variations in methodology and design in most studies made a thorough statistical analysis difficult. Instead, a frequency analysis of complications and a critical discussion were performed. RESULTS Although EUS-guided celiac plexus injection causes mainly mild and transient complications, growing experience shows that EUS-CPN is not as benign a procedure as previously thought. Most of the major complications have been observed in patients with chronic pancreatitis. The findings show that EUS-guided drainage of fluid collections is a safe procedure. Complications occur more often after the drainage of pancreatic abscesses and necrosis. Although the heterogeneity of studies dealing with pancreatobiliary drainage makes the evaluation of risks after these procedures difficult, complications after EUS-BD and EUS-PD are relatively frequent and can be severe. The technical complexity and the lack of specifically designed devices may account for their complication rates. CONCLUSIONS Clinicians can consider EUS-guided celiac injection and EUS-guided drainage of fluid collections to be safe alternatives to surgical and radiologic interventions. Well-designed prospective trials are needed to assess the risks of EUS-BD and EUS-PD accurately before they are broadly advocated after a failed endoscopic retrograde cholangiopancreatography (ERCP).
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Abstract
Endoscopy has an ever-increasing role in the treatment of complications in digestive surgery. Endoscopic treatment is essentially used for (i) fistula or intra-abdominal collection secondary to anastomotic dehiscence and (ii) anastomotic stricture, especially esophagogastric, but also sometimes after colorectal surgery. First intention treatment of fistula following esophagogastric surgery is the insertion of an extractable self-expandable metallic stent (partially or entirely covered); this is supported by a low level of scientific evidence, but clinical experience has been satisfactory. Other techniques for treatment of anastomotic leak have also been reported anecdotally (clip placement, sealing with glue). There are few data available in the literature on endoscopic management (stents essentially) of postoperative colonic fistula. Whatever the approach chosen to treat a postoperative digestive tract fistula, management is medico-surgical and cannot be limited to simple closure of the digestive tube wall defect. Drainage of any collections by endoscopic, radiologic or surgical approach, systemic treatment of infection and nutritional support are essential adjuvant treatment modalities. Treatment of postoperative esophageal or colonic strictures is essentially endoscopic and is based on initial dilatation (endoscopic with hydrostatic balloon or bougie), and placement of extractable metallic stents (partially or entirely covered) in case of refractory outcome.
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Affiliation(s)
- X Dray
- Université Paris Diderot, Paris 7, AP-HP, Service d'Hépatogastroentérologie, Hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France.
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Abstract
Crohn disease involves the perineum and rectum in approximately one-third of patients. Symptoms can range from mild, including skin tags and hemorrhoids, to unremitting and severe, requiring a proctectomy in a small, but significant, portion. Fistula-in-ano and perineal sepsis are the most frequent manifestation seen on presentation. Careful diagnosis, including magnetic resonance imaging or endorectal ultrasound with examination under anesthesia and aggressive medical management, usually with a tumor necrosis factor-alpha, is critical to success. Several options for definitive surgical repair are discussed, including fistulotomy, fibrin glue, anal fistula plug, endorectal advancement flap, and ligation of intersphincteric fistula tract procedure. All suffer from decreased efficacy in patients with Crohn disease. In the presence of active proctitis or perineal disease, no surgical therapy other than drainage of abscesses and loose seton placement is recommended, as iatrogenic injury and poor wound healing are common in that scenario.
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Affiliation(s)
- Robert T. Lewis
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Joshua I. S. Bleier
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania
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Ramesh J, Bang JY, Trevino J, Varadarajulu S. Comparison of outcomes between endoscopic ultrasound-guided transcolonic and transrectal drainage of abdominopelvic abscesses. J Gastroenterol Hepatol 2013; 28:620-5. [PMID: 23215873 DOI: 10.1111/jgh.12081] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transrectal endoscopic ultrasound (EUS)-guided pelvic abscess drainage has been reported, but data on transcolonic drainage are scant. AIM To compare outcomes in patients undergoing transcolonic and transrectal drainage of abdominopelvic abscesses. METHODS 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. RESULTS 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. CONCLUSION Except for patients with diverticular etiology, treatment of abdominopelvic abscess under EUS guidance is highly effective and safe for both routes.
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Affiliation(s)
- Jayapal Ramesh
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA.
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Gupta T, Lemmers A, Tan D, Ibrahim M, Le Moine O, Devière J. EUS-guided transmural drainage of postoperative collections. Gastrointest Endosc 2012; 76:1259-65. [PMID: 23021161 DOI: 10.1016/j.gie.2012.07.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/18/2012] [Indexed: 12/14/2022]
Affiliation(s)
- Tarun Gupta
- Department of Gastroenterology, Hepato-Pancreatology, and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Endoscopic-ultrasound-guided tissue sampling facilitates the detection of local recurrence and extra pelvic metastasis in pelvic urologic malignancy. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2012; 2012:219521. [PMID: 22778538 PMCID: PMC3388324 DOI: 10.1155/2012/219521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 04/10/2012] [Accepted: 04/24/2012] [Indexed: 01/12/2023]
Abstract
Pelvic lymph node dissection is the gold standard for assessing nodal disease in prostate or bladder cancer and is superior to CT, MRI and PET staging. Endoscopic ultrasound (EUS) provides an alternative, less invasive method of cytohistologic material acquisition, but its performance in pelvic urologic malignancy is unknown. Therefore, our aim was to evaluate the diagnostic accuracy of EUS guided tissue sampling for these malignancies when compared to a composite cytohistologic and surgical gold standard. A median of 3 FNA passes were performed (n = 19 patients) revealing a sensitivity, specificity, PPV and NPV of 94.4% (72–99), 100% (2–100), 100% (80–100) and 50% (1–98) respectively. The perirectal space was the most frequently sampled location irrespective of the primary urological cancer origin. Final diagnosis established by EUS tissue sampling included bladder cancer (n = 1), bladder cancer local recurrence (n = 8), bladder cancer extra pelvic metastases (n = 1), prostate cancer (n = 2), prostate cancer local recurrence (n = 4), prostate cancer extra pelvic metastases (n = 1), testicular cancer extra pelvic metastases (n = 1) and a benign seminal vesicle (n = 1). EUS guided sampling of the gut wall, lymph nodes, or perirectal space yields suitable diagnostic material to establish the presence of primary, local recurrence or extra pelvic metastases of pelvic urologic malignancy.
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Prasad GA, Varadarajulu S. Endoscopic ultrasound-guided abscess drainage. Gastrointest Endosc Clin N Am 2012; 22:281-90, ix. [PMID: 22632950 DOI: 10.1016/j.giec.2012.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Abdominal and pelvic abscesses have traditionally been drained by percutaneous techniques or surgery. While surgical drainage is associated with considerable morbidity and mortality, percutaneous techniques are associated with the need for multiple interventions, increased length of hospital stay, and an indwelling external catheter for prolonged periods. Endoscopic ultrasound (EUS) is a minimally invasive but highly effective technique that enables internal drainage of the abscess. Although data are limited, evidence supporting its clinical efficacy is increasing rapidly. This article summarizes the current status of EUS-guided approach for drainage of gastrointestinal abscess collections.
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Affiliation(s)
- Ganapathy A Prasad
- Division of Gastroenterology-Hepatology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905-0002, USA
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Martins BC, Marques CFS, Nahas CSR, Hondo FY, Pollara W, Nahas SC, Ribeiro Junior U, Cecconello I, Maluf-Filho F. A novel approach for the treatment of pelvic abscess: transrectal endoscopic drainage facilitated by transanal endoscopic microsurgery access. Surg Endosc 2012; 26:2667-70. [PMID: 22407154 DOI: 10.1007/s00464-012-2215-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 01/04/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Postoperative pelvic abscesses in patients submitted to colorectal surgery are challenging. The surgical approach may be too risky, and image-guided drainage often is difficult due to the complex anatomy of the pelvis. This article describes novel access for drainage of a pelvic collection using a minimally invasive natural orifice approach. METHODS A 37 year-old man presented with sepsis due to a pelvic abscess during the second postoperative week after a Hartmann procedure due to perforated rectal cancer. Percutaneous drainage was determined by computed tomography to be unsuccessful, and another operation was considered to be hazardous. Because the pelvic fluid was very close to the rectal stump, transrectal drainage was planned. The rectal stump was opened using transanal endoscopic microsurgery (TEM) instruments. The endoscope was advanced through the TEM working channel and the rectal stump opening, accessing the abdominal cavity and pelvic collection. RESULTS The pelvic collection was endoscopically drained and the local cavity washed with saline through the scope channel. A Foley catheter was placed in the rectal stump. The patient's recovery after the procedure was successful, without the need for further intervention. CONCLUSIONS Transrectal endoscopic drainage may be an option for selected cases of pelvic fluid collection in patients submitted to Hartmann's procedure. The technique allows not only fluid drainage but also visualization of the local cavity, cleavage of multiloculated abscesses, and saline irrigation if necessary. The use of TEM instrumentation allows safe access to the peritoneal cavity.
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Affiliation(s)
- B C Martins
- Department of Gastroenterology, Cancer Institute, São Paulo University, Av. Dr. Arnaldo, 251, São Paulo 01246-000, Brazil.
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Ulla-Rocha JL, Vilar-Cao Z, Sardina-Ferreiro R. EUS-guided drainage and stent placement for postoperative intra-abdominal and pelvic fluid collections in oncological surgery. Therap Adv Gastroenterol 2012; 5:95-102. [PMID: 22423258 PMCID: PMC3296086 DOI: 10.1177/1756283x11427420] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the role and benefits of endoscopic ultrasonography (EUS) in the management of postoperative intra-abdominal fluid collections after attempted curative surgery for abdominal cancer. METHODS The authors retrospectively analysed the Endobase from 1 July 2007 to 30 January 2011 for patients with a postoperative intra-abdominal fluid collection who had undergone EUS-guided drainage and the placement of a stent. The data analysed included the demographics, type of surgery and clinical indications of each patient as well as their clinical and radiological findings. RESULTS Six patients (three men and three women; mean age, 61.8 years [range, 38-78 years]) with intra-abdominal and pelvic fluid collections after abdominal surgery for cancer had undergone EUS-guided internal drainage. All procedures had been performed using linear EUS guidance and 8-Fr stent drainage catheters ('one step device', Giovannini, NWOA system Needle-Wire, Cook). The collection types included perigastric abscess (n = 3), perigastric hematoma and rectal hematoma (n = 1), perirectal biloma (n = 1), and perirectal abscess (n = 1). Patients had undergone the following types of surgery: lower-anterior rectal resection (n = 2), Whipple's duodenopancreatectomy type (n = 1), total gastrectomy (n = 1), splenectomy (n = 1), and distal pancreatectomy (n = 1). The number of stents inserted for each collection was one (five patients) and two (one patient). CONCLUSIONS EUS-guided drainage and stenting provide another option for the management of postoperative collections. It allows access to areas that are difficult to reach with the CT-guided approach and it can be performed accurately, efficiently and safely. In addition to this, the internal nature of the drainage offers patients more comfort.
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Affiliation(s)
- Jose Luis Ulla-Rocha
- Digestive Disease Service, Pontevedra Hospital Complex, C/Mourente s/n Pontevedra 36001, Spain
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Utility of EUS-guided biopsy of extramural pelvic masses. Gastrointest Endosc 2012; 75:146-51. [PMID: 22018550 DOI: 10.1016/j.gie.2011.08.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 08/15/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND The diagnostic utility of EUS-guided FNA (EUS-FNA) and EUS-guided Trucut biopsy (EUS-TCB) of pelvic masses has not been well described. OBJECTIVE To evaluate the utility of EUS in the diagnosis of pelvic masses. DESIGN Retrospective cohort study. SETTING Single tertiary referral hospital in Indianapolis, Indiana. PATIENTS Consecutive patients referred for EUS evaluation of pelvic mass from January 2002 to July 2009. Patients with newly diagnosed rectal cancer or a known/suspected intramural mass were excluded. INTERVENTIONS EUS-FNA and/or EUS-TCB. MAIN OUTCOME MEASUREMENTS Endosonographic features and cytological and pathological findings were evaluated. The final diagnosis was confirmed by surgical pathology or cytology and clinical follow-up. The sensitivities and specificities of EUS-TCB were calculated in a subset of patients with available surgical pathology. RESULTS A total of 69 patients were identified, and 40 with intramural lesions (n = 36) or incomplete follow-up (n = 4) were excluded. The remaining 29 patients (15 men, mean age 58.5 ± 10.8 years) with pelvic masses (mean size 40.8 ± 20.1 mm) were evaluated. EUS-FNA or EUS-TCB helped to make the diagnosis in 25 of 29 patients (86%). Compared with surgical pathology (available in 17 patients), EUS-FNA had a sensitivity of 88% (95% CI, 53%-98%) and specificity of 100% (95% CI, 65%-100%) for malignancy. EUS-TCB alone had a sensitivity of 67% (95% CI, 21%-94%) and specificity of 100% (95% CI, 34%-100%) for malignancy, but the combination of EUS-FNA and EUS-TCB had a sensitivity of 100% (95% CI, 68%-100%) and a specificity of 100% (95% CI, 68%-100%). Complications after EUS-FNA included a pelvic abscess in 2 patients (7%) with a cystic pelvic mass. LIMITATION Single-center study. CONCLUSION EUS-FNA and EUS-TCB are sensitive for the diagnosis of malignancy in pelvic masses. Sampling of cystic masses in this region is discouraged.
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EUS-guided drainage of a mediastinal collection complicating FNA of a bronchogenic cyst. Gastrointest Endosc 2011; 73:1306-8. [PMID: 21111409 DOI: 10.1016/j.gie.2010.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Accepted: 09/07/2010] [Indexed: 02/08/2023]
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