Volume 86 - 2023 - Fasc.3 - Original articles
EUS-guided transrectal drainage of pelvic abscesses: a retrospective analysis of 17 patients
Abstract
Background: Pelvic abscess is a common complication of
abdominal surgery or intestinal or gynecological diseases. Over
the last decades, endoscopic ultrasound (EUS)-guided drainage
has emerged as a minimally invasive alternative to percutaneous or
surgical treatment of pelvic abscesses.
Aim: To evaluate safety and efficacy of EUS-guided transrectal
pelvic abscess drainage in a single center.
Methods: From February 2017 to April 2023, all data on patients
who were treated for pelvic abscesses by EUS-guided drainage in a
single center, were retrospectively analyzed.
Results: A total of 17 patients were treated for pelvic abscesses
by EUS-guided drainage. The procedure was technically successful
and uneventful in all 17 patients (100%). Etiology of the abscess
was postsurgical (n=5, 29%), secondary to medical illness (n=10,
59%) or gastrointestinal perforation (n=2, 12%). The abscess was
multilocular in 5 patients (29%), the mean largest diameter was 76
mm (range 40-146 mm). Drainage was performed using 2 double
pigtail stents, and in 1 patient an additional 10 Fr drainage catheter
was deployed. Two patients (12%) required a second endoscopic
intervention. Treatment success, defined by complete abscess
resolution on follow-up CT scan along with symptom relief, was
100%. There was no need for surgical intervention. The median
post-procedural hospital stay was 5 days. No recurrence was
reported within a median time of follow-up of 39 months.
Conclusion: EUS-guided transrectal drainage of pelvic abscesses
using double pigtail stents is safe and highly effective. This case
series contributes to the cumulative evidence that, in expert hands,
EUS-guided drainage should be considered as first-line approach
for treatment of pelvic abscesses.
Clinical evaluation of the severity of acute pancreatitis in elderly patients
Background and study aims: Acute pancreatitis incidence in
geriatric patients has increased in recent years. The aim of this
study is to compare the clinical outcomes, laboratory findings of
acute pancreatitis among patients aged 65-74 years, 75-84 years
and ≥85 years.
Patients and methods: This retrospective study analyzed 500
patients aged 65 years and above, who were diagnosed with acute
pancreatitis between 2012 and 2022. They were categorized into
three groups based on their age: 65-74 years, 75-84 years, and ≥85
years. The primary outcome of the study focused on comparing
the hospital mortality rates among the three age groups. The
secondary outcomes involved comparing the length of hospital
stay, intensive care unit admission, rates of endoscopic retrograde
cholangiopancreatography (ERCP), and cholecystectomy
requirement among the three age groups.
Results: The study’s primary outcome is the significantly higher
mortality rate in the oldest age group (p=0.002). In addition,
patients with a Bedside index score ≥3, severe pancreatitis
according to the revised Atlanta criteria, necrotizing pancreatitis,
and drug-induced pancreatitis had significantly higher mortality
rates. Hospitalized patients in the intensive care unit also showed a
statistically significant increase in mortality rates. Interestingly, the
rate of cholecystectomy operations was significantly lower in the
group with higher mortality (p=0.030). When evaluated in terms
of secondary outcomes, no significant difference was found in all
three age groups.
Conclusions: The findings of this study indicate that the oldest
age group had a significantly higher mortality rate compared to the
other age groups. As a result, early diagnosis and prompt treatment
are of utmost importance to enhance outcomes in this vulnerable
population.
Clinical characteristics of hepatocellular carcinoma in patients with cirrhosis: a comparative cohort study
Background and study aims: The epidemiology of cirrhosis has changed over the last two decades. We aimed to assess whether the epidemiology and clinical presentation of hepatocellular carcinoma (HCC) occurring in cirrhosis has changed .
Patients and methods: The patients were recruited from the Cirrhosis Registry. This database included patients with cirrhosis who had attended the outpatient’ liver clinic at the Centre Hospitalier Jolimont in La Louvière, Belgium, since January 1995. We extracted data on two cohorts of patients with cirrhosis collected over an identical time period and followed up for the same duration.
Results: Cohort 1 included 504 patients enrolled from 1995 to 2005; among them, 89 patients developed HCC during the defined follow-up period (group 1). Cohort 2 included 566 patients enrolled from 2006 to 2016, among whom 73 patients developed HCC during the defined follow-up period (group 2). When patients with HCC in both groups were compared, no differences were found in the age at HCC diagnosis, the test that alerted on the presence of HCC, the extension, and the stage of the lesion at diagnosis. In the group 1, hepatitis C virus-related HCC occurred in 53% of the cases compared with 18% in the group 2 (P<0.001). Alcohol-related HCC occurred in 27% in the group 1 compared with 60% in the group 2 (P<0.001). The prevalence of metabolic dysfunction-associated steatotic liver disease-related HCC accounted for 10% in all groups.
Conclusion: The general epidemiology of HCC has not changed; however the etiology of underlying cirrhosis has changed.
