EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos)

BackgroundCurrently, percutaneous drainage is the first treatment of choice for hepatic abscesses because of its high success and low mortality rates compared with other surgical procedures. However, percutaneous drainage of hepatic abscesses in the caudate lobe or gastrohepatic space may be difficult.ObjectiveThe aim of this study was to determine the technical feasibility and clinical implication of EUS-guided drainage for hepatic abscesses not accessible to percutaneous biliary drainage.DesignSingle-center prospective case series.SettingAcademic tertiary referral center.PatientsThis study involved 3 consecutive patients with hepatic abscesses not accessible to percutaneous biliary drainage: 2 in the caudate lobe and 1 in the gastrohepatic extension from the posteromedial aspect of the lateral segment.InterventionsEUS-guided drainage with a plastic stent and/or nasocystic tube was conducted using a therapeutic linear-array echoendoscope under endoscopic and fluoroscopic guidance.ResultsThe EUS-guided transgastric approach was performed in 2 patients (1 in the caudate lobe, and 1 in the gastrohepatic space). In the other patient (caudate lobe), EUS-guided transduodenal drainage was conducted. EUS-guided drainage with the placement of a plastic stent and/or nasocystic tube was successful in all of the patients. Complete resolution of the hepatic abscesses and symptom relief were achieved in all of the patients (3 out of 3, 100%). No procedural complications were observed. Follow-up results were also favorable.LimitationsSmall series of cases.ConclusionsFor this case series, EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage, such as those in the caudate lobe or gastrohepatic space, is technically feasible, safe, and provides complete drainage, symptom relief, and favorable follow-up results.