Clinical Outcome of Endoscopic Ultrasound-Guided Liver Abscess Drainage Using Self-Expandable Covered Metallic Stent (with Video)

Abstract

Background

Percutaneous drainage (PCD) is now the first-line drainage method for liver abscess because of its minimal invasiveness and high technical success rate. However, this procedure has several disadvantages, such as extra-drainage and self-tube removal. Recently, EUS-guided liver abscess drainage (EUS-AD) has been developed. However, only a few reports of EUS-AD have been reported. In addition, the clinical benefits of PCD and EUS-AD have not been reported.

Aims

In the present study, the safety and feasibility of EUS-AD using fully covered SEMS (FCSEMS) and the clinical outcomes of EUS-AD and PCD were examined retrospectively.

Methods

Twenty-seven consecutive patients who underwent PCD or EUS-AD between April 2012 and April 2015 were included in this study. EUS-AD was performed using FCSEMS. In addition, to prevent stent migration, 7-Fr pig tail plastic stent was placed within FCSEMS.

Results

Technical success was achieved in all patients of both groups. Clinical success was 100 % in the EUS-AD group although it was 89 % in PCD group (P = 034). Three adverse events were seen in the PCD group (self-tube removal n = 1, tube migration n = 2), but no adverse events were seen in the EUS-AD group. The median hospital stay was significantly shorter in the EUS-AD group than in the PCD group (21 vs 41 days, P = 0.03).

Conclusion

Because of the short hospital stay, the high clinical success rate, and the low adverse event rate compared to PCD, EUS-AD has potential as a first-line treatment for liver abscess.

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References

  1. 1.

    Yu CHS, Ho SMS, Lau WY, et al. Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration. Hepatology. 2004;4:932–938.

    Article  Google Scholar 

  2. 2.

    Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. AJR. Am J Roentegnol. 2007;3:W138–W142.

    Article  Google Scholar 

  3. 3.

    Tan YM, Chung YFA, Chow KHP, et al. An appraisal of surgical and percutaneous drainage for pyogenic liver abscesses lager than 5cm. Ann Surg. 2005;3:485–490.

    Article  Google Scholar 

  4. 4.

    Huang CJ, Pitt HA, Lipsett PA, et al. Pyogenic hepatic abscess. Changing trends over 42 years. Ann Surg. 1996;223:600–609.

    CAS  PubMed Central  Article  PubMed  Google Scholar 

  5. 5.

    Rahimian J, Wilson T, Orman V, et al. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004;11:1654–1659.

    Article  Google Scholar 

  6. 6.

    Ogura T, Higuchi K. Dose endoscopic ultrasound-guided biliary drainage really have clinical impact? World J Gastroenterol. 2015;28:1049–1052.

    Article  Google Scholar 

  7. 7.

    Itoi T, Yasud I, Kurihara T, et al. Technique of endoscopic ulrasonography-guided pancreatic duct intervention (with videos). J Hepatobiliary Pancreat Sci. 2014;21:E4–E9.

    Article  PubMed  Google Scholar 

  8. 8.

    Seewald S, Imazu H, Omar S, et al. EUS-guided drainage of hepatic abscess. Gastrointest Endosc. 2005;61:495–498.

    Article  PubMed  Google Scholar 

  9. 9.

    Ang TL, Seewald S, Teo EK, et al. EUS-guided drainage of ruptured liver abscesses. Endoscopy. 2009;41:E21–E22.

    Article  PubMed  Google Scholar 

  10. 10.

    Noh SH, Park do H, Kim YR, et al. EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos). Gastrointest Endosc. 2010;71:1314–1319.

    Article  PubMed  Google Scholar 

  11. 11.

    Itoi T, Ang T, Seewald S, et al. Endoscopic ultrasonography guided drainage for tuberculous liver abscess drainage. Dig Endosc. 2011;23:158–161.

    Article  PubMed  Google Scholar 

  12. 12.

    Keohane J, DiMaio CJ, Schattner MA, et al. EUS guided transgastric drainage of caudate lobe liver abscess. J Interv Gastroenterol. 2011;1:139–141.

    PubMed Central  PubMed  Google Scholar 

  13. 13.

    Medrado BF, Carneiro FO, Vilaça TG, et al. Ensoscopic ultrasound-guided drainage of giant liver abscess associated with transgastric migration of self-expandable metallic stent. Endoscopu. 2013;45:E331–E332.

    Article  Google Scholar 

  14. 14.

    Alcaide N, Vargas-Garcia AL, de la Serna-Higuera C, et al. EUS-guided drainage of liver abscess by using a lumen-apposing metal stent (with video). Gastrointest Endosc. 2013;78:941–942. (discussion 942).

    Article  PubMed  Google Scholar 

  15. 15.

    Kawakami H, Kawakubo K, Kuwatani M, et al. Endoscopic ultrasound-guided liver abscess drainage using a dedicated, wide, fully covered self-expandable metallic stent with flared-ends. Endoscopy. 2014;46:E982–E983.

    Article  PubMed  Google Scholar 

  16. 16.

    Tonozuka R, Itoi T, Tsuchiya T, et al. EUS-guided drainage of hepatic abscess and infected biloma using short and long metal stent (with videos). Gastrointest Endosc. Epub. 04/02/2015.

  17. 17.

    Cotton PB, Eisen GM, Aabakken L, et al. A lexicon for endoscopic adverse event: report of an ASGE workshop. Gastrointest Endosc. 2010;71:446–454.

    Article  PubMed  Google Scholar 

  18. 18.

    Onder A, Kapan M, Böyük A, et al. Surgical management of pyogenic liver abscess. Eur Rev Med Pharmacol Sci. 2011;15:1182–1186.

    CAS  PubMed  Google Scholar 

  19. 19.

    Ferraioli G, Garlaschelli A, Zanaboni D, et al. Percutaneous and surgical treatment of pyogenic liver abscesses: observation over a 21-year period in 148 patients. Dig Liver Dis. 2008;40:690–696.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Ogura T, Sano S, Onda S, et al. Endoscopic ultrasound-guided biliary drainage for right hepatic bile duct obstruction: novel technical tips. Endoscopy. 2015;47:72–75.

    PubMed  Google Scholar 

  21. 21.

    Ogura T, Masuda D, Imoto A, et al. Novel method of endoscopic ultrasound-guided hepacticogastrostomy to prevent for stent migration. J Gastroenterol Hepatol. 2014;29:1815–1821.

    Article  PubMed  Google Scholar 

  22. 22.

    Itoi T, Isayama H, Sofuni A, et al. Stent selection and tips on placement technique of EUS-guided biliary drainage: transduodenal and transgastric stenting. J Hepatobiliary Pancreat Sci. 2011;18:664–672.

    Article  PubMed  Google Scholar 

  23. 23.

    Bapaye A, Itoi T, Kongkam P, et al. New fully covered large-bore wide-flare removable metal stent for drainage of pancreatic fluid collections: results of a multicenter study. Dig Endosc. 2015;27:499–504.

    Article  PubMed  Google Scholar 

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Correspondence to Takeshi Ogura.

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After liver abscess was punctured, the contrast medium was injected. Then, 0.025 inch guidewire was inserted. To dilate fistula, ERCP catheter was inserted. Fully covered self-expandable metallic stent was successfully placed from liver abscess and the duodenum. Supplementary material 1 (AVI 24657 kb)

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Ogura, T., Masuda, D., Saori, O. et al. Clinical Outcome of Endoscopic Ultrasound-Guided Liver Abscess Drainage Using Self-Expandable Covered Metallic Stent (with Video). Dig Dis Sci 61, 303–308 (2016). https://doi.org/10.1007/s10620-015-3841-3

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Keywords

  • Liver abscess
  • Endoscopic ultrasound-guided liver abscess drainage
  • Endoscopic ultrasound-guided fine-needle aspiration
  • Endoscopic ultrasound-guided drainage
  • Interventional EUS
  • Endoscopic ultrasound