title: EUS-guided transesophageal, transgastric, and transcolonic drainage of intra-abdominal fluid collections and abscesses.
abstract: BACKGROUND
  The therapeutic role of EUS is evolving. We report our experience with EUS-guided transesophageal, transgastric, and transcolonic drainage of various intra-abdominal fluid collections.
  
  
  OBJECTIVE
  To determine the technical feasibility and clinical outcomes of EUS-guided drainage.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  Patients referred for endoscopic drainage of intra-abdominal fluid collections; pancreatic pseudocysts amenable to conventional transgastric or transduodenal drainage were excluded.
  
  
  METHODS
  Single-step EUS-guided drainage of fluid collections by using a therapeutic linear-array echoendoscope with fluoroscopic guidance.
  
  
  METHODS
  Technical success, relief of symptoms, and procedural complications.
  
  
  RESULTS
  Nine consecutive patients deemed appropriate for EUS-guided drainage of intra-abdominal fluid collections included transesophageal drainage of pseudocysts (n = 2), transgastric drainage of biloma (n = 2) and upper intra-abdominal abscesses (n = 2), transcolonic drainage of diverticular abscess (n = 1), Crohn's abscess (n = 1), and postoperative hematoma (n = 1). Endoscopic drainage was successful in all patients. Confirmation of complete resolution of the target fluid collection and symptom relief was achieved in 8 (89%) of 9 patients. Pneumothorax and mediastinitis developed in 1 patient after transesophageal drainage, which resolved with chest tube and medical therapy. During multiple stent placement, one of the stents was fully deployed into the abscess cavity in 2 patients; both were successfully retrieved either endoscopically (Crohn's abscess) or at the time of primary colonic resection (diverticular abscess).
  
  
  CONCLUSIONS
  Limited number of patients.
  
  
  CONCLUSIONS
  EUS-guided transenteric drainage of bilomas, hematomas, abscesses, and inflammatory fluid collections is technically feasible and generally results in complete drainage and symptom relief. Procedural complications may be minimized with more experience.
authors: Division of Gastroenterology, University of Colorado Denver, Aurora, Colorado, USA.
authors: Cyrus
authors: C
authors: Piraka
authors: Raj J
authors: RJ
authors: Shah
authors: Norio
authors: N
authors: Fukami
authors: Krishnavel V
authors: KV
authors: Chathadi
authors: Yang K
authors: YK
authors: Chen
mesh_terms: D018784:Abdominal Abscess / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D001646:Bile; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography; D005240:Feasibility Studies; D005260:Female; D006406:Hematoma; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome