Background and Aim Endoscopic ultrasonography (EUS)‐guided drainage (EUS‐D) has become the standard treatment for peripancreatic fluid collections. Its use in other intra‐abdominal abscesses has been reported, although there is limited evidence. Methods We carried out a single‐center retrospective cohort study comparing percutaneous drainage (PCD) and EUS‐D of upper abdominal abscesses between January 2012 and June 2017. Pancreatic fluid collections and liver transplant recipients were excluded. Primary endpoints were technical and clinical success rates. Results We included 18 EUS‐D (nine hepatic and nine intraperitoneal abscesses) and 62 PCD. There were no differences regarding age, gender and etiology. Size was larger in the PCD group (80 vs 65.5 mm, P = 0.04) and perivesicular location was more frequent in the PCD group (24.2% vs 11.1%, P = 0.003). In the EUS‐D group, metal stents were deployed in 16 (88.9%) subjects (eight lumen‐apposing metal stents and eight self‐expandable metal stents), coaxial double‐pigtail plastic stents in six (33.3%) and lavage/debridement was carried out in five (27.8%). There were no significant differences in technical success (EUS‐D: 88.9%, PCD: 96.8%, P = 0.22) or clinical success (EUS‐D: 88.9%, PCD: 82.3%, P = 0.50), with no relapses in the EUS‐D group and 10 (16.1%) in the PCD group (P = 0.11). There were four (22.2%) adverse events in the EUS‐D group, none of them severe, and 13 (21%) in the PCD group (P = 0.91). Conclusions EUS‐D is an alternative to PCD in the treatment of upper abdominal abscesses, reaching similar success, relapse and adverse events rates.
Background and Aim: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an emerging option for acute cholecystitis in non-surgical candidates. Combining endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones with EUS-GBD in a single session might become a non-surgical management strategy to comprehensively treat gallstone disease in selected patients. Methods:Single-center retrospective cohort study comparing outcomes between EUS-GBD alone (group A) and single-session ERCP combined with EUS-GBD (group B). Consecutive patients who underwent EUS-GBD with a lumen-apposing metal stent (LAMS) between June 2011 and August 2018 were analyzed. Exclusion criteria were subjects included in randomized clinical trials, patients who had had ERCP within 5 days of EUS-GBD, patients in whom ERCP or EUS-GBD was carried out for salvage of one or the other procedure, and patients who underwent concurrent EUS-guided biliary drainage. Results: One hundred and nine consecutive patients under-went EUS-GBD with LAMS during the study period. Seventy-one patients satisfied the inclusion criteria and 34 patients were in group A and 37 in group B. Baseline characteristics were similar in both groups. There were no significant differences in technical (97.1% vs 97.3%; P = 0.19) and clinical success rates (88.2% vs 94.6%; P = 0.42) of EUS-GBD in group A versus group B. Rate of adverse events was similar in both groups, five (14.7%) in group A versus five (13.5%) in group B. Conclusions:Single-session EUS-GBD combined with ERCP has comparable rates of technical and clinical success to EUS-GBD alone. A combined EUS-GBD and ERCP procedure does not appear to increase adverse events and makes possible comprehensive treatment of gallstone disease by purely endoscopic means.
Background: Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) has proved effective in patients with cholecystitis at high surgical risk. The long-term risks of gallstone-related disease and stent-related adverse events are unknown. Methods: We performed a retrospective evaluation of a case series including subjects who underwent EUS-GBD using lumen-apposing metal stents (LAMS). Patients were identified from a prospective LAMS registry at a single tertiary center. Patients with a stent indwell time <1 year were excluded. Data regarding stent deployment and adverse events were retrieved from the prospective LAMS registry, while emergency room visits, admissions and causes of death were retrieved from electronic medical records. Results: We included 22 patients with a median age of 88.3 years (interquartile range [IQR]: 82.6-92.7), 14 (63.6%) were male. Median follow up was 24.4 months (IQR: 18.2-42.4) and median time to the last available imaging procedure was 607 days (IQR: 463-938). No LAMS-related adverse events were identified beyond the first year of follow up. During follow up, 12 patients (54.5%) visited the emergency room 34 times (1 visit/patient, IQR: 0-3) and a total of 36 hospital admissions were required, with a median of 1 admission/patient (IQR: 0-3). Fourteen (63.6%) patients died during follow up. Only 1 patient (4.5%) required new hospital admissions for gallstone-related disease. Conclusions: There were no adverse events beyond the first year after stent deployment, with only 4.5% of subjects requiring gallstone-related admissions. Permanent EUS-GBD with LAMS may be a definitive treatment for acute cholecystitis in patients ineligible for cholecystectomy.
We present the case of a 47-year-old man that was admitted to the Department of Digestive Diseases due to epigastric abdominal pain, nausea, and vomiting over a three week period. Laboratory tests highlighted the presence of anemia (7 mg/dl) and elevated amylase (153 U/l), lipase (190 U/l), and PCR (100 mg/l). An abdominal ultrasound was performed in which gallstones were observed as well as a destructured pancreas with an adjacent large hyperdense collection. By means of an abdominal computerized tomography scan (CT) the presence of acute pancreatitis with necrosis at the level of the pancreatic head, peripancreatic collections, and a 12 cm hematoma at the level of the gastric wall were noted (Fig. 1). Conservative treatment was established with good clinical evolution. A follow-up CT two months later showed a decrease in the size of the hematoma. DiscussionIntramural hematomas of the gastrointestinal tract are an infrequent pathology. The majority of them occur in the duodenal wall, and a gastric location is less common (1). The most usual etiology is via trauma although it can also be related with endoscopic procedures, ulcer disease, or coagulation disorders (2). Few cases have been described in relation to acute pancreatitis (2-4). In that context it can occur as a result of the irritative effect of pancreatic enzymes on the vascular structures, as well as the compression of pancreatic necrosis and peripancreatic collections over adjacent structures (4).The management of these patients should be conservative in the absence of important active bleeding or other complications. Otherwise, vascular embolization by radiology is a safe and minimally invasive option, reserving surgery for selected cases (1).
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