Post written by Carlos Robles-Medranda, MD, from the Instituto Ecuatoriano de Enfermedades Digestivas (IECED), Guayaquil, Ecuador.

We present a case study of an unilocular collection in the sixth segment of the liver that persisted after treatment with broad-spectrum antibiotic therapy.

Because of comorbidities, full-dose anticoagulation, and high cardiovascular, surgical, and bleeding risks of percutaneous drainage, the patient underwent EUS-guided drainage despite the distance and location between the abscess and the first portion of the duodenal wall.

Placing the EUS transducer 16.8 mm from the collection, we performed FNA, revealing purulent content. Then, a 0.035-mm guidewire was placed, and an electrocautery-enhanced delivery system lumen-apposing metal stent (LAMS) (HotAxios; Boston Scientific, Marlborough, Mass, USA) was inserted to drain the collection.

Two weeks later, CT evaluation revealed complete abscess resolution. At 1-month follow-up, granulation tissue was noticed through the LAMS.

With this study, we propose a new potential indication for liver abscess using an endoscopic approach, thus avoiding adverse events (eg, dislodgment, peritoneal spillage) and burden of extracorporeal drainage perceived with the classic percutaneous approach. This may represent a new indication for LAMS, considering that other types of stents (eg, double-pigtail plastic stents, self-expandable metal stents) hold great risk of peritoneal contamination and bleeding and a higher risk of migration.

In this case, because of the anchor flanges, a LAMS successfully managed the sixth hepatic segment collection with a low risk of migration. Further research is required to evaluate its usefulness and compare its efficacy with that of other stents.

Effective drainage of remotely located collections (far from the first portion of the duodenal wall), such as this right-sided hepatic abscess, is plausible despite the anticipated conjecture of a LAMS’s inability to do so because of length. Nonetheless, our case sets grounds for a new LAMS indication to mitigate intra-abdominal fluid collections.

Intracavity appearance after lumen-apposing metal stent insertion and antibiotic instillation.

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