EUS-guided endoscopic internal drainage with lumen-apposing metal stent for symptomatic hepatic cysts: a case series (with video)

First-intention EUS-guided transluminal drainage with LAMS: an effective and safe method for management of fluid collections after any kind of surgery

BACKGROUND

Symptomatic postoperative collections (PCs) frequently complicate surgery with significant morbidity and mortality. In contrast with pancreatic inflammatory collections, little is known about endoscopic ultrasound-guided drainage of PCs (EUS-PCD). The aim of this study is to evaluate the safety and efficacy of EUS-PCD using lumen-apposing metal stent (LAMS) as the first-line drainage approach for PCs of any kind.

METHODS

This is a monocentric retrospective study. We retrieved all consecutive symptomatic PCs treated at our center between February 2019 and September 2024. All cases were considered suitable for EUS-PCD after multidisciplinary discussion. Rates of technical success, clinical success, and AEs were calculated.

RESULTS

We retrieved 66 PCs, mainly resulting from pancreatic and lower gastrointestinal tract surgery. The median size of collections was 7.6 cm and infection occurred in 54 of the cases. The median time from surgery to drainage was 19 days (IQR 13-29); in 10 cases, this occurred ≤ 7 days after surgery. 51 drainages were performed from the gastric/duodenal window, 15 transrectally. LAMS were removed after a median time of 18.5 days (IQR 12-27). After removal, double-pigtail stents were placed in 25 PCs and at least one necrosectomy session was performed in 13. Technical success was achieved in 97.0% of cases. Clinical success was achieved in 95.2%; in 3 cases, collection recurrence occurred and retreatment with LAMS was successful. Overall AEs rate was 9.1%, but only one was severe, requiring surgery. Rates of technical and clinical failure and AEs were not affected by surgery type (pancreatic, non-pancreatic), timing of drainage (≤ 7, 7-10, > 10 days), size of collections (≤ 4, 4-10, > 10 cm), and access window (transgastric/duodenal/rectal). Necrosectomy performance was the only predictor of AEs occurrence (OR 6.9, C.I.: 1.1-46.9, p = 0.048) at univariable analysis.

CONCLUSION

First-intention EUS-PCD seems to be a safe and effective treatment, regardless of the origin and size of the collection and drainage timing.

Comparison of endoscopic ultrasound-guided drainage and percutaneous drainage combined with minocycline sclerotherapy for symptomatic hepatic cysts: A retrospective study

Simple hepatic cysts (SHC) are generally asymptomatic and incidentally diagnosed using imaging studies. Asymptomatic SHC does not require treatment, but symptomatic SHC warrants treatment using different modalities, including intravenous antibiotic therapy, ultrasound-guided percutaneous catheter drainage (PCD) with sclerotherapy, and surgery. The dissemination of endoscopic ultrasonography (EUS) intervention techniques has enabled the performance of puncture and drainage via the transgastrointestinal route for intra-abdominal abscesses. Despite the development of an EUS-guided drainage method for treating symptomatic SHC, only a few case reports using this method have been reported. This study retrospectively analyzed the safety and feasibility of EUS-guided drainage of symptomatic SHC as well as its clinical outcomes and compared it with combined therapy using PCD and minocycline sclerotherapy. The records of 10 consecutive patients with 11 symptomatic SHCs treated with either EUS-guided drainage or PCD combined with minocycline sclerotherapy at the Musashino Tokushukai Hospital from August 2019 to January 2024 were retrospectively examined. All cases in both groups achieved technical and clinical success, with no reported adverse events. The median reduction rates of the major cyst diameters in the EUS-guided drainage and PCD with sclerotherapy groups were 100% (interquartile range [IQR]: 94%-100%) and 67% (IQR: 48.5%-85%). The length of hospital stay was 7 and 22.5 days in the EUS-guided and PCD with sclerotherapy groups (P = .01). EUS-guided drainage of symptomatic SHC is a safe and effective therapeutic alternative to percutaneous drainage with sclerotherapy and surgery for treating symptomatic SHC.