Endoscopic ultrasound‐guided pelvic abscess drainage (with video)

Pelvic abscesses present a serious and challenging management problem. Endoscopic ultrasound (EUS)‐guided drainage provides a safe and effective minimally invasive treatment option. The likelihood of a successful outcome is dependent on appropriate patient selection, drainage technique and postoperative management. This review outlines the evidence behind and procedural steps required for EUS‐guided pelvic abscess drainage.     

Elastography of pancreatic ductal adenocarcinoma following EUS-guided radiofrequency ablation (with video)

Patients presenting with pancreatic ductal adenocarcinoma in an advanced inoperable stage receive chemoradiotherapy. Endoscopic ultrasound guided radiofrequency ablation (EUS-RFA) has been proposed as a new therapeutic option for these patients alongside chemotherapy. The evaluation of treatment response is mainly based on radiological evaluation of the changes in tumour size. Unfortunately, the currently available radiological methods cannot clearly differentiate between necrotic tissue and viable tumour. EUS elastography is an ultrasound technique that can grade the hardness of a lesion and classify it as benign, inflammatory or neoplastic as previously reported. This case report of 2 patients shows that using EUS elastography is beneficial in characterizing the nature of the changes occurring to the tumour mass following EUS-RFA of pancreatic tumour.     

Endoscopic therapy of a splenic abscess: definitive treatment via EUS-guided transgastric drainage

BACKGROUND: Splenic complications of pancreatitis are exceedingly rare, occurring in only 2.2% of cases. Patients typically present in a dramatic fashion and often need an urgent procedure to prevent overwhelming infection or hemorrhage. Historically, the procedures involve surgery (distal pancreatectomy and splenectomy) or percutaneous drainage. SETTING: Walter Reed Army Medical Center. PATIENT: A patient with acute or chronic pancreatitis presented with pleuritic chest pain and fever up to 105 degrees F (40.6 degrees C). A CT of the abdomen and the pelvis demonstrated a splenic abscess. INTERVENTION: Because of the technical inability to perform transpapillary drainage, EUS-guided transgastric drainage resolved the splenic abscess. CONCLUSIONS: This is the first reported case of a splenic abscess treated definitively with endoscopic therapy. In the face of a worsening clinical picture and reported morbidities up to 79% with surgical and percutaneous drainage procedures, endoscopic therapies should be considered in the management of splenic complications of pancreatitis.