EUS-guided drainage of a segment VI liver abscess using a lumen-apposing metal stent

https://www.videogie.org/cms/asset/6bf5f915-fe75-48cc-ad36-02774ea973ee/mmc1.mp4Loading ...(mp4, 77.12 MB) Download video EUS-guided FNA and lumen-apposing metallic stent deployment. A 66-year-old male patient with hypertension, unstable angina antiplatelet treatment, previous cholecystectomy presented to our institution a fever abdominal pain for the past 3 weeks. Blood analyses revealed leukocytosis increased reactive C protein levels. contrast-enhanced CT scan US identified 5.7- × 6- 4.8-cm uniloculated collection in sixth segment of right liver lobe that persisted despite treatment broad-spectrum antibiotic therapy (Fig. 1). Because cardiovascular comorbidities, clopidogrel surgical morbidity bleeding risk percutaneous drainage. The home medication was replaced aspirin 75 mg daily, 5 days prior procedure. multidisciplinary team decided attempt drainage difficult-to-reach location long distance between abscess first portion duodenal wall. EUS transducer placed at minimum 16.8 mm from collection, avoiding vessel or bowel loop interposition. performed 19-gauge needle purulent content. Afterward, 0.035-mm guidewire left place, exclusively under guidance, 15- 10-mm electrocautery-enhanced delivery system metal (LAMS) (HotAxios; Boston Scientific, Marlborough, Mass, USA) inserted successfully into 2). balloon dilation up 15 through stent, cavity rinsed sterile water, 160 gentamicin, 500 metronidazole 3; Video 1, available online www.videogie.org).Figure 2A, appearance abscess. B, Distance wall collection. C, Drainage stent.View Large Image Figure ViewerDownload Hi-res image (PPT)Figure 3Intracavity after insertion instillation.View (PPT) discharged same day, evaluation 2 weeks later showed complete disappearance 4). cultured pus positive trimethoprim-sulfamethoxazole sensitive Burkholderia spp. Granulation tissue noticed LAMS 1-month follow-up 5). After removal, an over-the-scope-clip (Ovesco Endoscopy AG, Tübingen, Germany) used defect closure (Video 2, www.videogie.org). 4-month no recurrence.Figure 5Granulation inside 4 drainage.View study comparing abscesses using self-expandable stents (SEMSs) 27 patients significant differences technical clinical success but shorter relapse rate group. This is probably because large caliber (30F vs 12F tubes).1Ogura T. Masuda D. Saori O. et al.Clinical outcome endoscopic ultrasound-guided covered (with video).Dig Dis Sci. 2016; 61: 303-308Crossref Scopus (26) Google Scholar Double-pigtail plastic are preferred low costs vast experience, there high peritoneal contamination while dilating tract, procedure time, need multiple interventions.2Chin Y.K. Asokkumar R. Endoscopic difficult-to-access abscesses.SAGE Open Med. 2020; 82050312120921273Crossref (7) SEMS better option poses migration.2Chin LAMSs have intra-abdominal spillage migration rates anchor flanges, short length does not permit collections located far distances.2Chin Scholar,3Carbajo A.Y. Brunie Vegas F.J. García-Alonso al.Retrospective cohort upper abscesses.Dig Endosc. 2019; 31: 431-438Crossref (15) In contrast side liver, right-sided hepatic adherent gastric even more difficult access GI lumen. To date, only 10 cases been described.2Chin Scholar,4Tonozuka Itoi Tsuchiya al.EUS-guided infected biloma videos).Gastrointest 2015; 81: 1463-1469Abstract Full Text PDF PubMed 83.3% end session 100% second.4Tonozuka Stent encountered cases.4Tonozuka without adverse events.2Chin Despite being off-label indication LAMSs, this seems be alternative SEMSs. However, its use literature. Regardless main limitation represented by we managed drain help guidewire. Dr Robles-Medranda consultant key opinion leader Pentax Medical, Steris, Medtronic, Motus, Microtech, G-Tech Medical Supply, CREO EndoSound, Mdconsgroup. All other authors disclosed financial relationships. ... .mp4 (77.12 Help files 1EUS-guided deployment.Video 2. Closure over-the-scope-clip.https://www.videogie.org/cms/asset/579b565b-5f41-421e-92f8-15f6a466b390/mmc2.mp4Loading (14.82 2Closure over-the-scope-clip.