title: Long-term outcome of endoscopic ultrasound-guided pelvic abscess drainage: a two-center series.
abstract: Background and study aimEndoscopic ultrasound (EUS)-guided pelvic abscess drainage has been reported but long-term data remain limited. This two-center study evaluated long-term outcome of EUS-guided pelvic abscess drainage.Patients and methodsBetween May 2003 and December 2015, 37 consecutive patients were treated for perirectal or perisigmoid abscesses via EUS-guided drainage using plastic or lumen-apposing metal stent (LAMS). Clinical success was defined as complete resolution of the abscess on follow-up computed tomography (CT) scan at 4 weeks with symptom relief. Long-term success was defined as abscess resolution without the need for surgery and without recurrence on long-term follow-up (> 12 months).ResultsMedian abscess size was 60 mm (interquartile range 41 - 70). Causes were postsurgical (n = 31, 83.8 %) or secondary to medical conditions (n = 6, 16.2 %). EUS-guided drainage involved needle aspiration (n = 4), plastic stent placement (n = 29) or LAMS placement (n = 4 patients). Technical and clinical success was achieved in 37 patients (100 %; 95 % confidence interval [CI] 91 - 100) and 34 patients (91.9 %; 95 %CI 78 - 98), respectively (5 patients needed a second EUS-guided intervention within 14 days after drainage). One patient required surgery and one required best supportive care owing to persistent abscess. Early complications were perforation requiring surgery (n = 1), stent migration (n = 1), and rectal discomfort (n = 1). At a median follow-up of 64 months (IQR 19 - 81), two patients experienced abscess recurrence, at 3 and 12 months, respectively, and were treated surgically. Long-term success was achieved in 32 of 37 patients (86.5 %; 95 %CI 71 - 95).ConclusionEUS-guided drainage of pelvic abscess is safe, has good long-term outcome, and should be considered as an alternative to percutaneous and surgical drainage.
authors.affiliation: Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Poincloux
authors.affiliation: Endoscopy Unit, Paoli Calmette Institute, Marseille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Caillol
authors.affiliation: Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Allimant
authors.affiliation: Endoscopy Unit, Paoli Calmette Institute, Marseille, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Bories
authors.affiliation: Endoscopy Unit, Paoli Calmette Institute, Marseille, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Pesenti
authors.affiliation: Biostatistics Unit, DRCI, Gabriel Montpied University Hospital, 63003 Clermont-Ferrand, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Mulliez
authors.affiliation: Clinical Research Unit, Estaing University Hospital, Clermont-Ferrand, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Faure
authors.affiliation: Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rouquette
authors.affiliation: Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Dapoigny
authors.affiliation: Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France.
authors.forename: Armando
authors.initials: A
authors.lastname: Abergel
authors.affiliation: Endoscopy Unit, Paoli Calmette Institute, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011475:Prosthesis Failure / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult