Post written by Yervant Ichkhanian, MD, from the Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan, and Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA, and Tobias Zuchelli, MD, from Division of Gastroenterology and Hepatology, Henry Ford Hospital.

This multicenter study evaluates whether 15-mm lumen-apposing metal stents (LAMSs) outperform 10-mm LAMSs for EUS-guided drainage of intra-abdominal abscesses, focusing on safety, effectiveness, and procedure burden.

Intra-abdominal abscesses—often adverse events from abdominal surgery—are traditionally treated with percutaneous or surgical drainage. Both methods carry drawbacks: high failure rates with percutaneous drainage and increased morbidity with surgery. EUS-guided drainage using LAMSs offers a minimally invasive alternative, but the optimal stent size remains unclear.

Of 51 patients, 29 received 15-mm LAMSs and 22 received 10-mm LAMSs. Baseline characteristics were comparable. Abscesses were mostly postoperative and located peri-pancreatic or peri-gastric. Results included:

• Technical success rates were high: 97% (15 mm) and 100% (10 mm).
• Clinical success also was comparable: 96% (15 mm) versus 95% (10 mm).
• Patients with 15-mm LAMSs required fewer procedures on average (2.5 vs 3.6; P < .023).
• The adverse event rate was low in both groups. One patient in the 15-mm group experienced fatal GI bleeding. Three events occurred in the 10-mm group: 2 stent migrations and 1 fistula, all managed endoscopically.

No recurrences occurred among those who achieved clinical success. Most patients underwent follow-up imaging at around 3.6 weeks to confirm resolution.

Both LAMS sizes were highly effective and safe for EUS-guided abscess drainage. Although the 15-mm LAMS group showed a trend toward fewer procedures and slightly higher clinical success, the difference was not statistically significant. The single fatal event in the 15-mm group underscores the importance of careful patient selection and postprocedural monitoring.

These findings support the growing role of EUS-guided drainage as a first-line option in centers with appropriate expertise. Future prospective studies are needed to clarify optimal stent sizing and postdrainage management strategies, such as the use of plastic stents or fistula closure after LAMS removal.

Management and the treatment approach of patients with intra-abdominal abscess. LAMS, Lumen-apposing metal stent.

Read the full article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.