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CC BY 4.0 · Journal of Digestive Endoscopy 2025; 16(01): 008-016
DOI: 10.1055/s-0045-1805039
Research Article

Endoscopic Ultrasound-Guided Drainage of Difficult-to-Access Liver Abscesses: A Large Single-Center Experience

Sharad Chandra
1   Department of Gastroenterology, Meghraj Memorial Hospital, Jhansi, Uttar Pradesh, India
› Author Affiliations Funding None declared.
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Abstract

Objective

Endoscopic ultrasound (EUS)-guided drainage can be a minimally invasive alternative approach in draining radiologically inaccessible liver abscesses. However, experience with EUS-guided drainage is limited with no guidelines available.

The objective of this study was to share our experience in EUS-guided drainage of radiologically inaccessible liver abscesses.

Materials and Methods

Retrospective analysis of prospectively maintained database of patients who underwent EUS-guided liver abscess drainage from 2017 to May 2024 was done. Demographics, clinical data, procedural data, and adverse events were collected. Abscesses were analyzed for their location, number, size, puncture distance, indication of drainage, route of access, and the endoprosthesis used for drainage.

Statistical Analysis

Results were reported as mean or median (range) for quantitative variable and percentage for categorical variable.

Results

A total of 46 patients (44 males and 2 females) underwent EUS-guided liver abscess drainage. Transmural drainage was done in 31 (67.4%) and aspiration in 15 (32.6%) patients. The mean size of abscess collection was 6.55 ± 0.33 cm. The puncture distance was <2 cm in 38, 2–4 cm and >4 cm in 4 each. Location of abscess was caudate lobe in 10 (24.4%), segment 2 in 4 (8.7%), segment 3 in 11 (23.9%), segment 4 in 7 (15.2%), segment 5 in 3 (6.5%), segment 6 in 4 (8.7%), segment 7 in 1(2.17%), and segment 8 in 6 (13%). Access was transesophageal in 7 (15.2%), transduodenal in 17 (36.9%), and transgastric in 22 (47.8%). Seven patients underwent trans-segmental drainage. Segment 8 was accessed through segment 5 or caudate lobe in three patients each, and segment 7 through segment 6 in one patient. 10F nasocystic drain (NCD) was used as endoprosthesis in all patients who underwent transmural drainage except one. Technical and clinical success of EUS-guided drainage was 100%.

Conclusion

EUS-guided drainage with its excellent safety profile and clinical success should always be considered for draining radiologically inaccessible liver abscesses before contemplating surgical drainage. 10F NCD works well as endoprosthesis with excellent results irrespective of approach, location, thick abscess contents, and in ruptured abscesses. EUS-guided trans-segmental drainage is technically feasible and clinically effective.

Keywords

endoscopic ultrasound - endoprosthesis - liver abscess drainage - percutaneous drainage - radiologically inaccessible abscess

Earlier Presentation

• Oral abstract in ISGCON VARANASI 2024.


• Asian EUS cup in Asian EUS Congress June 2023.


• Video abstract (Abstract ID 1353–891) in APDW 2021.


• Abstract ENDO 2022 Kyoto Japan published in DEN 2022.


• Case series Endoscopy Int open 2021;9(1):E 35–40.


Study was conducted as per the guidelines in the Declaration of Helsinki.


Ethics Statement

The study was performed in accordance with the Code of Ethics of the World Medical Association.


Approval of Research Protocol by an Institutional Review Board

N/A.


Inform Consent

Yes.


Registry and Registration No. of the Study

N/A.


Animal Studies

N/A.




Publication History

Article published online:
19 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Sharma S, Ahuja V. Liver abscess:complications and treatment. Clin Liver Dis (Hoboken) 2021; 18 (03) 122-126
    CrossrefPubMedSearch in Google Scholar
  • 2 Chin YK, Asokkumar R. Endoscopic ultrasound-guided drainage of difficult-to-access liver abscesses. SAGE Open Med 2020; 8: 2050312120921273
    CrossrefPubMedSearch in Google Scholar
  • 3 Seewald S, Imazu H, Omar S. et al. EUS-guided drainage of hepatic abscess. Gastrointest Endosc 2005; 61 (03) 495-498
    CrossrefPubMedSearch in Google Scholar
  • 4 Ang TL, Seewald S, Teo EK, Fock KM, Soehendra N. EUS-guided drainage of ruptured liver abscess. Endoscopy 2009; 41 (2, Suppl 2): E21-E22
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Noh SH, Park DH, Kim YR. et al. EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos). Gastrointest Endosc 2010; 71 (07) 1314-1319
    CrossrefPubMedSearch in Google Scholar
  • 6 Itoi T, Ang TL, Seewald S. et al. Endoscopic ultrasonography-guided drainage for tuberculous liver abscess drainage. Dig Endosc 2011; 23 (Suppl. 01) 158-161
    CrossrefPubMedSearch in Google Scholar
  • 7 Keohane J, Dimaio CJ, Schattner MA, Gerdes H. EUS-guided transgastric drainage of caudate lobe liver abscesses. J Interv Gastroenterol 2011; 1 (03) 139-141
    PubMedSearch in Google Scholar
  • 8 Ivanina E, Mayer I, Li J. et al. EUS- guided drainage of hepatic abscess. Gastrointest Endosc 2012; 75 (04) AB114
    CrossrefSearch in Google Scholar
  • 9 Medrado BF, Carneiro FO, Vilaça TG. et al. Endoscopic ultrasound-guided drainage of giant liver abscess associated with transgastric migration of a self-expandable metallic stent. Endoscopy 2013; 45 (Suppl. 02) E331-E332
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Alcaide N, Vargas-Garcia AL, de la Serna-Higuera C, Sancho Del Val L, Ruiz-Zorrilla R, Perez-Miranda M. EUS-guided drainage of liver abscess by using a lumen-apposing metal stent (with video). Gastrointest Endosc 2013; 78 (06) 941-942
    CrossrefPubMedSearch in Google Scholar
  • 11 Kawakami H, Kawakubo K, Kuwatani M. et al. Endoscopic ultrasonography-guided liver abscess drainage using a dedicated, wide, fully covered self-expendable metallic stent with flared-end. Endoscopy 2014; 46 (01) 982-983
    Search in Google Scholar
  • 12 Koizumi K, Masuda S, Uojima H. et al. Endoscopic ultrasound-guided drainage of an amoebic liver abscess extending into the hepatic subcapsular space. Clin J Gastroenterol 2015; 8 (04) 232-235
    CrossrefPubMedSearch in Google Scholar
  • 13 Kodama R, Saegusa H, Ushimaru H, Ikeno T, Makino M, Kawaguchi K. Endoscopic ultrasonography-guided drainage of infected intracystic papillary adenocarcinoma of the liver. Clin J Gastroenterol 2015; 8 (05) 335-339
    CrossrefPubMedSearch in Google Scholar
  • 14 Tonozuka R, Itoi T, Tsuchiya T. et al. EUS-guided drainage of hepatic abscess and infected biloma using short and long metal stents (with videos). Gastrointest Endosc 2015; 81 (06) 1463-1469
    CrossrefPubMedSearch in Google Scholar
  • 15 Ogura T, Masuda D, Saori O. et al. Clinical outcomes of endoscopic ultrasound-guided liver abscess drainage using self-expandable covered metallic stent (with video). Dig Dis Sci 2016; 61 (01) 303-308
    CrossrefPubMedSearch in Google Scholar
  • 16 Yamamoto K, Itoi T, Tsuchiya T, Tanaka R, Nagakawa Y. EUS–guided drainage of hepatic abscess in the right lobe of a liver of a patient with chilaiditi syndrome. VideoGIE 2017; 2 (11) 299-300
    CrossrefPubMedSearch in Google Scholar
  • 17 Carbajo AY, Brunie Vegas FJ, García-Alonso FJ. et al. Retrospective cohort study comparing endoscopic ultrasound-guided and percutaneous drainage of upper abdominal abscesses. Dig Endosc 2019; 31 (04) 431-438
    CrossrefPubMedSearch in Google Scholar
  • 18 Rana SS, Ahmed S, Sharma R, Gupta R. Safety and efficacy of EUS-guided drainage of liver abscess: a single-center experience. Endosc Ultrasound 2020; 9 (05) 350-351
    CrossrefPubMedSearch in Google Scholar
  • 19 Chandra S, Chandra U. Endoscopic ultrasound-guided transgastric drainage of radiologically inaccessible left lobe liver abscess involving segment 4, caudate lobe, and left lateral segments using a modified technique. Endosc Int Open 2021; 9 (01) E35-E40
    Thieme ConnectPubMedSearch in Google Scholar
  • 20 Molinario F, Rimbaş M, Pirozzi GA. et al. Endoscopic ultrasound-guided drainage of a fungal liver abscess using a lumen-apposing metal stent: case report and literature review. Rom J Intern Med 2021; 59 (01) 93-98
    PubMedSearch in Google Scholar
  • 21 Zanwar S, Agarwal M. Endosonography-guided caudate lobe liver abscess drainage: a case and review of methods. J Dig Endosc 2022; 13: 119-124
    Thieme ConnectSearch in Google Scholar
  • 22 Shah J, Jena A, Singh AK, Jearth V, Dutta U. Endoscopic ultrasound (EUS)-guided drainage of caudate lobe abscess: a single center experience. Surg Laparosc Endosc Percutan Tech 2023; 33 (06) 682-687
    CrossrefPubMedSearch in Google Scholar
  • 23 Shahid H, Tyberg A, Sarkar A. et al. EUS-guided versus percutaneous liver abscess drainage: a multicenter collaborative study. Endosc Ultrasound 2023; 12 (06) 472-476
    CrossrefPubMedSearch in Google Scholar