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DOI: 10.1055/s-0038-1637316
RETROSPECTIVE COHORT STUDY EVALUATING CLINICAL OUTCOMES OF PERCUTANEOUS AND ENDOSCOPIC ULTRASOUND-GUIDED DRAINAGE OF UPPER ABDOMINAL ABSCESSES
Publication History
Publication Date:
27 March 2018 (online)
Aims:
Although percutaneous drainage (PTD) is recommended as first line treatment for intraabdominal abscesses, EUS-guided drainage (EUS-D) has been successfully employed in hepatic and postsurgical intraabdominal abscesses. We aimed at comparing safety, feasibility and clinical outcomes of upper abdominal abscesses undergoing percutaneous or EUS-guided drainage.
Methods:
We present a single center retrospective cohort study including all consecutive patients undergoing PTD or EUS-D of upper abdominal abscesses between January 2012 and June 2017. Peripancreatic fluid collections related to acute pancreatitis and subjects with a previous history of liver transplantation were excluded.
Results:
We included 80 patients, 18 EUS-D and 62 PTD. There were no differences between cohorts regarding age, sex and etiology. Size was larger in the PTD group (80 vs. 65.5 mm, p = 0.04) and perivesicular location was more frequent in the PTD group (24.2% vs. 11.1%, p = 0.003).
The transgastric route was chosen in 14 (77.8%) EUS-D. Metal stents were deployed in 16 (89.9%) subjects (9 lumen apposing metal stents and 7 SEMS). Double pig-tail plastic stents were placed in 6 (33.3%) patients and lavage/debridement was performed in 5 (27.8%).
Procedure outcomes are shown in table 1. There were 4 (22.2%) adverse events (3 mild hemorrhages and one perforation solved during the endoscopic procedure) in the EUS-D group and 13 (21%) in the PTD group (p = 0.91), 7 of them severe.
EUS-guided drainage (n = 18) |
Percutaneous drainage (n = 62) |
p value |
|
Technical success, n (%) |
16 (88.9%) |
60 (96.8%) |
0.22 |
Clinical success, n (%) |
16 (88.9%) |
51 (82.3%) |
0.50 |
Time to clinical success (days), med (IQR) |
17.5 (5.5 – 25.5) |
17 (7 – 27) |
0.71 |
Relapse, n (%) |
0 |
7 (11.3%) |
0.11 |
Conclusions:
EUS-D presents a similar efficacy compared to PTD, with a non-significant reduction in the number of relapses. These results warrant the development of prospective randomized trials comparing both approaches.