EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos).
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.
Noh
Se Hui
SH
Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea.
Park
Do Hyun
DH
Kim
Yi Rang
YR
Chun
Yoonhee
Y
Lee
Han Chu
HC
Lee
Sang Oh
SO
Lee
Sang Soo
SS
Seo
Dong Wan
DW
Lee
Sung Koo
SK
Kim
Myung-Hwan
MH
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