Related Experiment Video
Updated: Jun 13, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage (with videos)
Se Hui Noh1, Do Hyun Park, Yi Rang Kim
1Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736, Korea.
Insights
Endoscopic ultrasound (EUS)-guided drainage offers a safe and effective solution for hepatic abscesses, particularly those challenging for percutaneous methods. This minimally invasive technique successfully resolved abscesses in all patients, providing symptom relief and favorable outcomes.
Area of Science:
- Gastroenterology
- Interventional Endoscopy
- Hepatology
Background:
- Percutaneous drainage is the primary treatment for hepatic abscesses.
- Access to caudate lobe or gastrohepatic space abscesses can be challenging via percutaneous routes.
Observation:
- This study evaluated endoscopic ultrasound (EUS)-guided drainage for hepatic abscesses.
- Three patients with abscesses inaccessible to percutaneous drainage underwent EUS-guided procedures.
- Techniques included transgastric and transduodenal approaches using stents or nasocystic tubes.
Findings:
- EUS-guided drainage was technically feasible and successful in all three patients.
- Complete resolution of hepatic abscesses and symptom relief were achieved in 100% of cases.
- No procedural complications were observed, with favorable follow-up results.
Implications:
- EUS-guided drainage is a viable, safe, and effective alternative for difficult-to-access hepatic abscesses.
- This approach offers complete resolution and symptom relief, improving patient outcomes.
- Further research with larger cohorts is warranted to confirm these findings.
Background:
Currently, percutaneous drainage is the first treatment of choice for hepatic abscesses because of its high success and low mortality rates compared with other surgical procedures. However, percutaneous drainage of hepatic abscesses in the caudate lobe or gastrohepatic space may be difficult.
Objective:
The aim of this study was to determine the technical feasibility and clinical implication of EUS-guided drainage for hepatic abscesses not accessible to percutaneous biliary drainage.
Design:
Single-center prospective case series.
Setting:
Academic tertiary referral center.
Patients:
This study involved 3 consecutive patients with hepatic abscesses not accessible to percutaneous biliary drainage: 2 in the caudate lobe and 1 in the gastrohepatic extension from the posteromedial aspect of the lateral segment.
Interventions:
EUS-guided drainage with a plastic stent and/or nasocystic tube was conducted using a therapeutic linear-array echoendoscope under endoscopic and fluoroscopic guidance.
Results:
The EUS-guided transgastric approach was performed in 2 patients (1 in the caudate lobe, and 1 in the gastrohepatic space). In the other patient (caudate lobe), EUS-guided transduodenal drainage was conducted. EUS-guided drainage with the placement of a plastic stent and/or nasocystic tube was successful in all of the patients. Complete resolution of the hepatic abscesses and symptom relief were achieved in all of the patients (3 out of 3, 100%). No procedural complications were observed. Follow-up results were also favorable.
Limitations:
Small series of cases.
Conclusions:
For this case series, EUS-guided drainage of hepatic abscesses not accessible to percutaneous drainage, such as those in the caudate lobe or gastrohepatic space, is technically feasible, safe, and provides complete drainage, symptom relief, and favorable follow-up results.
