Is EUS-Guided Single-Step Complete-Aspiration Useful In The Management Of Abdominal Collections?

Aims Most endoscopic management of abdominal collections includes Endoscopic Ultrasound (EUS)-guided transmural drainage or transpapillary drainage via ERCP. EUS-guided single-step complete-aspiration (SSCA) is little reported and there are some doubts about its real effectiveness.

Methods Specific database review and retrospective cohort identification that includes abdominal collections treated by EUS-guided SSCA. The decision to apply this strategy was based on collection size and endoscopist criteria. Exclusion: transmural and/or transpapillary drainage. Technical success: needle access inside the collection and complete liquid aspiration liquid with total collapse. Clinical success defined as reduction ≥ 50 % of initial size or decrease <50 % with clinical improvement, in subsequent imaging control. Failure: whether increased collection or need for clinical re-intervention. Other variables: demographics, procedure techniques, collection (etiology, size, infection), re-intervention, safety.

Results Of 180 collections endoscopically treated, selection of 42 patients and including 40 (23 men, mean age 55years (SD13.6)). Exclusion of 2 cases due lack of follow-up. Collections data: mean size 55-mm (SD19.7); liquid vs solid-content, 77 vs 23 %; positive culture in 45 %; pancreatic inflammatory nature in 85 % (n-34, including 67 % pseudocyst and 41 % chronic pancreatitis). Technical success of 100 %, clinical success of 50 % with a first session and 60 % after two. Adverse events detected in 5 %: one procedure-related bleeding, and one patient with abdominal pain. The most used needle type, 19 G (87 %). Mean follow-up, 574-days (SD 442).

No identification of factors related to clinical success (Table). Subgroup analysis according to collection etiology without differences. Failed-SSCA management: 40 % conservative attitude vs 60 % re-intervention, endoscopic 66.6 % (other SSCA in 4; transmural pigtail placement in 3, and lumen-apposing stent in 1), in 25 % percutaneous and 8.3 % surgery.

Tab. 1

Sex (Men/Female), n (%)	11(47)/9(52)	0.74
Etiology (pancreatic/non-pancreatic), n (%)	15(44)/5(83)	0.077
Microbiology (positive/negative), n (%)	7(38)/13(68)	0.072
Age, mean (SD), years Clinical success group Non-clinical success group	56.3 (15.0) 56.5 (12.2)	0.493
Collection size, mean (SD), mm Clinical success group Non-clinical success group	56.8 (17.6) 54.6 (22.4)	0.414

Conclusions In a percentage of selected abdominal collections treatment by EUS-SSCA could save a more aggressive strategy. No specific factor associated with failure of this strategy has been identified.

Citation Velasquez-Rodriguez JG, Maisterra S, Colan Hernandez J et al. eP447 IS EUS-GUIDED SINGLE-STEP COMPLETE-ASPIRATION USEFUL IN THE MANAGEMENT OF ABDOMINAL COLLECTIONS? Endoscopy 2021; 53: S244.

Publication History

Article published online:
19 March 2021