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Could Transgastric Endoscopic Ultrasound-Guided Aspiration Alone Be Effective for the Treatment of Pancreatic Abscesses?

Jo HG, Amarbat B, Jeong JW, Song HY, Song SR, Kim TH - Clin Endosc (2015)

Bottom Line: Endoscopic ultrasound (EUS)-guided endoscopic drainage is less invasive than surgery and prevents local complications related to percutaneous drainage.Endoscopic drainage with stent placement in the uncinate process of the pancreas is a technically difficult procedure.We report a case of pancreatic abscess treated by repeated EUS-guided aspiration and intravenous antibiotics without an indwelling drainage catheter or surgical intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.

ABSTRACT
Drainage of pancreatic abscesses is required for effective control of sepsis. Endoscopic ultrasound (EUS)-guided endoscopic drainage is less invasive than surgery and prevents local complications related to percutaneous drainage. Endoscopic drainage with stent placement in the uncinate process of the pancreas is a technically difficult procedure. We report a case of pancreatic abscess treated by repeated EUS-guided aspiration and intravenous antibiotics without an indwelling drainage catheter or surgical intervention.

No MeSH data available.


Related in: MedlinePlus

Endoscopic ultrasound (EUS) findings (transgastric view). (A) A low echoic lesion with irregular wall measuring approximately 3.6×2.1 cm is seen in the pancreatic head portion, suggestive of an abscess cavity. (B) A 22-gauge EUS-fine needle aspiration needle entering the cystic cavity for aspiration is visible (arrow).
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Figure 3: Endoscopic ultrasound (EUS) findings (transgastric view). (A) A low echoic lesion with irregular wall measuring approximately 3.6×2.1 cm is seen in the pancreatic head portion, suggestive of an abscess cavity. (B) A 22-gauge EUS-fine needle aspiration needle entering the cystic cavity for aspiration is visible (arrow).

Mentions: For diagnosis and drainage of the pancreatic abscess, both radial EUS (GF-UE 260-AL5; Olympus Co., Tokyo, Japan) and linear (UCT240-AL5; Olympus Co.) echo-endoscopes were introduced into the duodenal bulb for a transduodenal approach to the pancreatic abscess. During EUS evaluations, an active, large, and deep ulcer with an exposed vessel on the duodenal bulb was revealed (Fig. 2). We initially planned a transduodenal approach to the pancreatic abscess for EUS-guided fine needle aspiration (FNA). Unfortunately, this active duodenal ulcer required that we change our plan. The EUS endoscope was instead introduced into the antrum of the stomach, and ultrasound showed a low echoic lesion with an irregular wall including floating material, measuring 3.6×2.1 cm at the head of the pancreas (Fig. 3A). After selecting an appropriate aspiration site by ultrasound and Doppler inspection, a 22-gauge needle (EchoTip Ultra, ECHO 3-22; Cook Endoscopy, Winston-Salem, NC, USA) was introduced into the abscess (Fig. 3B) at the antrum; 14 mL of thick, purulent fluid with blood clots was aspirated. Prophylactic antibiotics had been administered on the day of the procedure. Cytological examination revealed inflammatory cells. Microbial analysis of the purulent material showed Klebsiella pneumoniae. Based on the bacterial culture results, the patient was administered third-generation cephalosporins intravenously for 10 days. On the seventh admission day, fever and leukocytosis occurred; the pancreatic lesion was again aspirated with the intention of complete drainage of the cavity using EUS-FNA 22-gauge. A total of 7 mL of purulent fluid was obtained, and the cavity size decreased after this second aspiration. The patient had no immediate or late complications, and his clinical and laboratory findings improved. After 3 months, the follow-up CECT demonstrated successful resolution of the pancreatic abscess.


Could Transgastric Endoscopic Ultrasound-Guided Aspiration Alone Be Effective for the Treatment of Pancreatic Abscesses?

Jo HG, Amarbat B, Jeong JW, Song HY, Song SR, Kim TH - Clin Endosc (2015)

Endoscopic ultrasound (EUS) findings (transgastric view). (A) A low echoic lesion with irregular wall measuring approximately 3.6×2.1 cm is seen in the pancreatic head portion, suggestive of an abscess cavity. (B) A 22-gauge EUS-fine needle aspiration needle entering the cystic cavity for aspiration is visible (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522430&req=5

Figure 3: Endoscopic ultrasound (EUS) findings (transgastric view). (A) A low echoic lesion with irregular wall measuring approximately 3.6×2.1 cm is seen in the pancreatic head portion, suggestive of an abscess cavity. (B) A 22-gauge EUS-fine needle aspiration needle entering the cystic cavity for aspiration is visible (arrow).
Mentions: For diagnosis and drainage of the pancreatic abscess, both radial EUS (GF-UE 260-AL5; Olympus Co., Tokyo, Japan) and linear (UCT240-AL5; Olympus Co.) echo-endoscopes were introduced into the duodenal bulb for a transduodenal approach to the pancreatic abscess. During EUS evaluations, an active, large, and deep ulcer with an exposed vessel on the duodenal bulb was revealed (Fig. 2). We initially planned a transduodenal approach to the pancreatic abscess for EUS-guided fine needle aspiration (FNA). Unfortunately, this active duodenal ulcer required that we change our plan. The EUS endoscope was instead introduced into the antrum of the stomach, and ultrasound showed a low echoic lesion with an irregular wall including floating material, measuring 3.6×2.1 cm at the head of the pancreas (Fig. 3A). After selecting an appropriate aspiration site by ultrasound and Doppler inspection, a 22-gauge needle (EchoTip Ultra, ECHO 3-22; Cook Endoscopy, Winston-Salem, NC, USA) was introduced into the abscess (Fig. 3B) at the antrum; 14 mL of thick, purulent fluid with blood clots was aspirated. Prophylactic antibiotics had been administered on the day of the procedure. Cytological examination revealed inflammatory cells. Microbial analysis of the purulent material showed Klebsiella pneumoniae. Based on the bacterial culture results, the patient was administered third-generation cephalosporins intravenously for 10 days. On the seventh admission day, fever and leukocytosis occurred; the pancreatic lesion was again aspirated with the intention of complete drainage of the cavity using EUS-FNA 22-gauge. A total of 7 mL of purulent fluid was obtained, and the cavity size decreased after this second aspiration. The patient had no immediate or late complications, and his clinical and laboratory findings improved. After 3 months, the follow-up CECT demonstrated successful resolution of the pancreatic abscess.

Bottom Line: Endoscopic ultrasound (EUS)-guided endoscopic drainage is less invasive than surgery and prevents local complications related to percutaneous drainage.Endoscopic drainage with stent placement in the uncinate process of the pancreas is a technically difficult procedure.We report a case of pancreatic abscess treated by repeated EUS-guided aspiration and intravenous antibiotics without an indwelling drainage catheter or surgical intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea.

ABSTRACT
Drainage of pancreatic abscesses is required for effective control of sepsis. Endoscopic ultrasound (EUS)-guided endoscopic drainage is less invasive than surgery and prevents local complications related to percutaneous drainage. Endoscopic drainage with stent placement in the uncinate process of the pancreas is a technically difficult procedure. We report a case of pancreatic abscess treated by repeated EUS-guided aspiration and intravenous antibiotics without an indwelling drainage catheter or surgical intervention.

No MeSH data available.


Related in: MedlinePlus