期刊
JOURNAL OF MINIMAL ACCESS SURGERY
卷 17, 期 4, 页码 513-518出版社
WOLTERS KLUWER MEDKNOW PUBLICATIONS
DOI: 10.4103/jmas.JMAS_184_20
关键词
Abscess; colon; diverticula disease; double pigtail; drainage; endoscopic ultrasound; LAMS; rectum
类别
The main treatment approach for diverticular disease is non-operative treatment with bowel rest and broad-spectrum intravenous antibiotics. This study reports a high success rate in technical and clinical outcomes for EUS-guided drainage with LAMS in diverticular disease patients with pelvic abscess, providing a potentially efficient treatment modality.
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.
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