title: EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos).
abstract: BACKGROUND
  Currently, percutaneous drainage is the first treatment of choice for hepatic abscesses because of its high success and low mortality rates compared with other surgical procedures. However, percutaneous drainage of hepatic abscesses in the caudate lobe or gastrohepatic space may be difficult.
  
  
  OBJECTIVE
  The aim of this study was to determine the technical feasibility and clinical implication of EUS-guided drainage for hepatic abscesses not accessible to percutaneous biliary drainage.
  
  
  METHODS
  Single-center prospective case series.
  
  
  METHODS
  Academic tertiary referral center.
  
  
  METHODS
  This study involved 3 consecutive patients with hepatic abscesses not accessible to percutaneous biliary drainage: 2 in the caudate lobe and 1 in the gastrohepatic extension from the posteromedial aspect of the lateral segment.
  
  
  METHODS
  EUS-guided drainage with a plastic stent and/or nasocystic tube was conducted using a therapeutic linear-array echoendoscope under endoscopic and fluoroscopic guidance.
  
  
  RESULTS
  The EUS-guided transgastric approach was performed in 2 patients (1 in the caudate lobe, and 1 in the gastrohepatic space). In the other patient (caudate lobe), EUS-guided transduodenal drainage was conducted. EUS-guided drainage with the placement of a plastic stent and/or nasocystic tube was successful in all of the patients. Complete resolution of the hepatic abscesses and symptom relief were achieved in all of the patients (3 out of 3, 100%). No procedural complications were observed. Follow-up results were also favorable.
  
  
  CONCLUSIONS
  Small series of cases.
  
  
  CONCLUSIONS
  For this case series, EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage, such as those in the caudate lobe or gastrohepatic space, is technically feasible, safe, and provides complete drainage, symptom relief, and favorable follow-up results.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea.
authors.forename: Se Hui
authors.initials: SH
authors.lastname: Noh
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Yi Rang
authors.initials: YR
authors.lastname: Kim
authors.forename: Yoonhee
authors.initials: Y
authors.lastname: Chun
authors.forename: Han Chu
authors.initials: HC
authors.lastname: Lee
authors.forename: Sang Oh
authors.initials: SO
authors.lastname: Lee
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D006801:Humans; D008100:Liver Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014741:Video Recording