Endoscopic transgastric drainage of a gastric wall abscess after endoscopic submucosal dissection

A 63-year-old woman was referred to our hospital for further examination because of an incidental finding of early gastric cancer.Endoscopic submucosal dissection(ESD)was successfully performed for complete resection of the tumor.On the first post-ESD day,the patient suddenly complained of abdominal pain after an episode of vomiting.Abdominal computed tomography(CT)showed delayed perforation after ESD.The patient was conservatively treated with an intravenous proton pump inhibitor and antibiotics.On the fifth post-ESD day,CT revealed a gastric wall abscess in the gastric body.Gastroscopy revealed a gastric fistula at the edge of the post-ESD ulcer,and pus was found flowing into the stomach.An intradrainage stent and an extradrainage nasocystic catheter were successfully inserted into the abscess for endoscopic transgastric drainage.After the procedure,the clinical symptoms and laboratory test results improved quickly.Two months later,a follow-up CT scan showed no collection of pus.Consequently,the intradrainage stent was removed.Although the gastric wall abscess recurred 2 wk after stent removal,it recovered soon after endoscopic transgastric drainage.Finally,after stent removal and oral antibiotic treatment for 1 mo,no recurrence of the gastric wall abscess was found.     

内镜超声下胰腺假性囊肿经胃置管引流的临床研究

目的分析探讨内镜超声（EUS）下胰腺假性囊肿经胃置管引流的疗效及并发症情况。方法回顾分析2001年以来经胃置管引流胰腺假性囊肿的24例患者病历及随访资料。引流方法采用EUS引导下穿刺囊肿，插入导丝，用探条或扩张水囊行针道扩张，置入鼻囊肿引流管或1～4根双猪尾型塑料支架引流。术后定期随访，囊肿消失后拔除支架。结果24例患者均完成囊肿穿刺、置管，手术成功率100％，死亡率为0。发生并发症8例（33．3％），其中严重并发症3例（12．5％），分别为出血、感染、支架移位各1例。平均随访21．2个月，2例失访，17例假性囊肿完全消失，2例囊肿明显缩小但持续存在2年以上，腹痛症状消失，1例感染性假性囊肿内镜引流无效转外科手术。内镜引流总的有效率为86．4％（19／22），无一例复发。结论EUS下经胃置管引流治疗胰腺假性囊肿是一种安全、有效的治疗方法，其常见并发症为出血和感染。     

EUS-guided drainage of pelvic abscess (with video)

BACKGROUND: Although pelvic abscesses have traditionally been drained by surgery or under radiologic guidance, a small subset of patients who are not candidates for these interventions require an alternate mode of drainage. OBJECTIVE: Evaluate the efficacy of EUS for drainage of pelvic abscesses that could not be drained under US or CT guidance. DESIGN: Prospective case series. SETTING: Tertiary referral center. PATIENTS: Four patients underwent EUS-guided drainage of pelvic abscesses that were not amenable for drainage by US and/or CT guidance. INTERVENTIONS: A 10F drainage catheter was deployed in the abscess cavity under EUS guidance in all patients. The catheters were flushed periodically until resolution of the abscess was confirmed by CT imaging. MAIN OUTCOME MEASUREMENTS: Resolution of a pelvic abscess on follow-up CT and improvement in clinical symptoms. RESULTS: A drainage catheter was successfully placed in all 4 patients. The mean size of the abscess was 68 x 72 mm. There were no procedure-related complications. One patient died of worsening congestive heart failure 48 hours after the procedure. The abscesses resolved in the remaining 3 patients within a mean duration of 6 days, with complete symptom relief. LIMITATIONS: A small number of patients and short duration of follow-up. CONCLUSIONS: EUS-guided placement of drainage catheter is a minimally invasive technique for draining pelvic abscesses that are within the reach of the echoendoscope.     

Percutaneous drainage of liver and splenic abscess

42 patients with solitary (n = 34) and multiple (n = 8) abscesses of the liver (n = 36) and the spleen (n = 6) were treated with ultrasound guided percutaneous interventions. 38 patients (90%) underwent a total of 97 closed abscess aspirations using needles of 0.9 and 1.3 mm in diameter. In 4 cases (10%) percutaneous catheter drainage was performed. Intravenous antibiotics were used in all cases. Those patients with closed abscess aspiration additionally received local injection of aminoglycosides into the cavity. 40 out of the 42 patients could be treated successfully by percutaneous methods for a cure rate of 95.2%. Percutaneous drainage failure occurred in 2.4%. One patient with multiple liver abscesses and catheter drainage died from myocardial infarction (hospital mortality 2.4%). Complications of ultrasound-guided interventions included two minor bleedings, requiring no therapy, and one pleural empyema (complication rate 7.1%). There were no treatment related lethal complications. These results indicate that abscesses of the liver and the spleen up to 10 cm in diameter can be effectively treated by closed (repetitive) needle aspiration and antibiotic therapy with a relatively low rate of complications. About half of our patients with abscesses of more than 10 cm received percutaneous catheter drainage. On the basis of our experience surgical drainage of liver abscesses and splenectomy in splenic abscesses should be restricted to those cases with percutaneous drainage failure.     

Stent selection and tips on placement technique of EUS-guided biliary drainage: transduodenal and transgastric stenting

Endoscopic ultrasonography-guided biliary drainage (EUS-BD) has been carried out as an alternative to the percutaneous or surgical approach when endoscopic retrograde cholangiopancreatography fails. However, there is no standard technique or device for EUS-BD. In this review, we focus on how we choose the stents and described our tips on this EUS-BD technique. The plastic stent (PS) and the self-expandable metallic stent (SEMS) are used for EUS-BD. The latter is further divided into the fully covered SEMS (FCSEMS), partially covered SEMS (PCSEMS), and uncovered SEMS (UCSEMS) types. Although PS is not expensive, the duration of stent patency is short. SEMS is expensive but the duration of stent patency is long. With UCSEMS, basically there is no stent malpositioning; however, if the gap between the bile duct and the GI tract becomes displaced, bile leakage from the mesh of the stent is likely to occur. Though there is no bile leakage with FCSEMS, the side branch of the bile duct may become occluded, and migration and dislocation sometimes occur. PCSEMS is basically similar to FCSEMS. When EUS-BD was first developed, drainage by PS was common, although reports on drainage by SEMS have increased recently.     

内镜超声引导下经胃穿刺置管引流治疗胰腺假性囊肿36例

目的:评价内镜超声(endoscopic ultrasound,EUS)胰腺假性囊肿经胃穿刺置管引流术的价值.方法:回顾性分析2005-02/2010-05于我院行EUS引导下经胃穿刺置管引流术的36例胰腺假性囊肿患者的临床资料.结果:本组36例患者中,34例成功完成穿刺和置管,成功率为94.4%(34/36).并发症发生率17.6%(6/34),分别为感染、支架堵塞与移位.平均手术时间为50(40-65)min.置入支架后平均住院时间为4.7(2-9)d.平均支架留存时间为6.9(4-11)mo.平均随访时间为30(10-60)mo.内镜治愈率为97.1%(33/34).未见囊肿复发.结论:EUS引导下经胃穿刺置管引流术是一种安全、有效、微创的治疗胰腺假性囊肿的方法.     

Endoscopic transpapillary abscess drainage for a patient with giant pyogenic liver abscess

The primary modalities for management of liver abscesses are usually antibiotics and percutaneous drainage. However, in patients with ascites or bleeding tendency, the percutaneous puncture of liver abscesses may be unsuitable. We applied a new approach, nasobiliary tube drainage, for a giant pyogenic liver abscess following diagnostic endoscopic retrograde cholangiopancreatography. Pyogenic liver abscess is often biliary in origin, and this new approach includes assessment of biliary abnormality for the management of the abscess, enabling treatment of parients in whom puncture of the abscess is considered dangerous because of massive ascites around the liver. We propose that this procedure is useful in the management of a subgroup of patients with pyogenic liver abscess. To our knowledge, no previous reports of endoscopic transpapillary abscess drainage in pyogenic liver abscess are available.     

新型金属支架用于内镜超声引导下经胃胰周积液引流的临床研究

目的 评价临床应用新型哑铃状覆膜金属支架经胃引流胰周积液(PFC）的有效性和安全性。方法 回顾性分析2015年9月至2017年4月期间长海医院应用新型哑铃状覆膜金属支架行内镜超声（EUS）引导下经胃引流PFC的46例患者病例和随访资料。结果 46例患者共行49次穿刺引流,包括3例同时置入2枚支架的患者。操作成功率95.9%（47/49）,总体并发症发生率31.8%（14/44）,其中严重并发症2例,分别为延迟性出血和腹膜炎。再介入率22.7%（10/44）,术后住院时间1~40 d,平均6 d。术后随访9~28个月,平均18.4个月,引流成功率90.9%（40/44）,支架拔除时间为20~142 d,平均59.4 d,PFC复发率10.0%（4/40）。结论 新型哑铃状覆膜金属支架用于EUS引导下PFC的经胃引流是有效和相对安全的。