Endoscopic ultrasound-guided drainage of intra-abdominal diverticular abscess. A case series
Gianfranco Donatelli1, Fabrizio Cereatti2, Maurizio Fazi1, Vincenzo Ceci1, Parag Dhumane3
1 Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France
2 Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, Paris, France; Department of Medical, Gastroenterology and Endoscopy Unit, ASST Cremona, Cremona, Italy
3 Department of Surgical, General and Laparoscopic Surgery Unit, Lilavati Hospital and Research Center, Mumbai, India
Department of Surgical, Interventional Endoscopy Unit, Private Hospital Peupliers-Ramsay Santé, 8 Place de l'Abbé G. Hénocque 75013, Paris
Source of Support: None, Conflict of Interest: None
Aim: Diverticular disease is widespread worldwide. Mainstay approach is non-operative treatment with bowel rest and broad-spectrum intravenous antibiotics. However, extra-colic abscess larger than 4 cm may require percutaneous trans-abdominal drainage. We report a single centre case series of patients underwent to trans-luminal endoscopic ultrasound (EUS)-guided drainage of pelvic abscess in diverticular disease with temporary placement of lumen apposing metal stent (LAMS).
Methods: All patients referred to our tertiary centre from January 2019 to July 2020 were enrolled in a prospective data base that was retrospectively analysed. Procedural steps were as follows: pre-operative computed tomography scan, broad-spectrum antibiotic therapy, EUS-guided deployment of LAMS for 15 days, LAMS removal and deployment of pigtail stent in case of pseudo-cavity persistence.
Results: Ten patients (6F) with an average of 59.6 years were enrolled with deployment of 10 LAMS. One patient was excluded after EUS evaluation and 1 patient had 2 LAMS for 2 separate abscesses. Technical and clinical success was achieved in 88.8% (8/9).
Conclusions: Management of diverticulitis has shifted from primary surgical intervention towards a non-operative approach of bowel rest and broad-spectrum intravenous antibiotics in conjunction with interventional procedures to drain abscesses whenever necessary. EUS-guided drainage with LAMS for the management of diverticular abscesses seems an efficient treatment modality for encapsulated abscesses more than 4 cm in size and close to colonic wall. In expert centres, it may avoid radiologic intervention and/or surgery in a relevant percentage of cases.