Post written by Andrea Lisotti, MD, from the Gastroenterology Unit, Hospital of Imola, University of Bologna, Italy, and the Gastroenterology Unit, Hôpital Privé Jean Mermoz, Lyon, France.

Our study evaluated the safety and efficacy of endoscopic ultrasound—guided pelvic abscess drainage (EUS-PAD) using lumen-apposing metal stents in patients with complicated acute diverticulitis. This minimally invasive approach is designed for patients in whom percutaneous drainage is impossible or contraindicated, often because of difficult anatomical access.

Pelvic abscesses in complicated diverticulitis are traditionally managed with percutaneous drainage or surgery. However, up to one-third of patients cannot undergo percutaneous drainage because of anatomical constraints, leaving urgent surgery as the only option—an approach associated with significantly higher morbidity and mortality. We aimed to assess whether EUS-PAD could serve as an effective rescue therapy to avoid urgent surgery in this high-risk population.

We retrospectively analyzed 53 patients treated in 3 high-volume centers between 2019 and 2023. Technical success was achieved in 92.5% of cases and clinical success in 88.7%, with only 3.8% experiencing mild adverse events. Notably, the need for urgent surgery was reduced to 4.1% among patients with technically successful drainage. Our findings suggest that EUS-PAD is a safe and effective alternative for managing complicated diverticulitis when other drainage approaches are infeasible. Further comparative studies are needed to confirm these results.

This study represents one of the largest and most homogeneous series of EUS-PADs in complicated diverticulitis to date, to our knowledge, reflecting the value of international collaboration. The procedure may significantly change the treatment paradigm for select patients, offering a less-invasive alternative with faster recovery.

Study flowchart. AD, Acute diverticulitis.

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