Post written by iGIE iNTERNATIONAL Associate Editor Diogo Turiani Hourneaux de Moura, MD, MSc, PhD, from the Gastrointestinal Endoscopy Unit, Gastroenterology Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, and the Gastrointestinal Endoscopy Unit, Hospital São Luiz Morumbi e Vila Nova Star, Instituto D’Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil.

The goal of this case report was to present a promising technique for the management of liver abscesses after conventional treatment failure.

We describe a novel homemade endoscopic vacuum therapy (EVT) combining drainage and lavage. This approach is feasible and appears to be safe and effective for managing liver abscesses, especially when conventional therapies fail. It allows bedside evaluation inside the collection and accurate control of responsiveness to treatment.

Furthermore, it enables therapeutic procedures such as direct necrosectomy.

This novel approach using percutaneous EVT combining drainage and lavage through a single device is a promising therapy. Its indication can be expanded for other intracavitary collections with no communication to the GI lumen, as a communication between the intraluminal compartment and the external tube would preclude defect closure because of continuous aspiration of GI fluids.

Moreover, this device allows customization of the negative pressure settings, duration of instillation cycles, and instillation volume.  

We believe that this therapy is superior to conventional percutaneous drainage, as the EVT tube is larger than percutaneous pigtail stents.

In addition, it presents a unique mechanism of action combining drainage and lavage, promoting macro- and micro-deformation and bacterial clearance, stimulating angiogenesis, and reducing exudate, thus improving healing. This approach appears to be ideal for collections with thick exudate and purulent content and solid, coagulative, fat necrosis.

Evolution of the endoscopic vacuum therapy (EVT) device. A polyurethane sponge is the standard device. However, it presents disadvantages, such as challenging insertion and tissue ingrowth, which increases the risk of bleeding. To overcome these limitations, the use of an open-pore film was reported, but it presents higher costs and limited availability. Our group described the homemade modified EVT constructed using a nasogastric tube, gauze, and antimicrobial incise drape. The modified EVT with instillation is an adaption of this device, which uses a double-lumen tube to allow aspiration and irrigation through the same device.

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