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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

Authors

  • Sharad Chandra

    1   Department of Gastroenterology, Meghraj Memorial Hospital, Jhansi, Uttar Pradesh, India

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.




Publikationsverlauf

Artikel online veröffentlicht:
19. März 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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