S5239 Use of Lumen-Apposing Metal Stents to Treat Tubo-Ovarian Abscesses

Introduction: Lumen-apposing metal stents (LAMS) were originally designed for transmural drainage of peripancreatic fluid collections. They are now increasingly utilized for numerous minimally invasive procedures as an alternative to surgical or percutaneous interventions. Tubo-ovarian abscesses, manifestations of pelvic inflammatory disease, that cannot be medically managed have historically required surgical or percutaneous intervention. At our academic medical center, we identified patients with tubo-ovarian abscesses for whom surgical and percutaneous procedures were contraindicated. In these cases, we designed and applied a novel method using LAMS for abscess drainage. Patients’ hospital course and outcomes compared to traditional treatment methods were analyzed. Case Description: Five female patients, ranging in age from 27 to 79 years old were identified. Each patient had clinical findings (abdominal pain, nausea, vomiting, and fever), leukocytosis, and computed tomography imaging suggestive of a tubo-ovarian abscess for which standard medical management would be ineffective. In each patient, interventional radiology could not find an adequate window allowing for percutaneous drainage. Our team performed lower endoscopic ultrasounds which revealed fluid collections of 3 cm, 3 cm, 6 cm, 7 cm, and 6 cm in each patient. We then successfully performed lower endoscopic ultrasound-guided transluminal drainage of these abscesses via short-term placement of a LAMS into the rectum. Purulent material draining from the stents was observed immediately after placement. Stents were removed after complete drainage of fluid collections. Total dwell time of the stents in each patient was 10, 16, 6, 24, and 4 days, respectively. Total length of hospital stay was 12, 22, 12, 7, and 8 days, respectively. Discussion: Analysis of outcomes after our procedure showed that all patients’ clinical conditions improved with no further complications, leukocytosis resolved, and total drainage of abscesses was achieved. Compared to conventional invasive interventions, this procedure reduces patient pain and discomfort, infection risk, and incomplete drainage risk. It also preserves fertility, has higher success rates, and allows for shorter hospital stays and quicker recovery. We have established how transrectal drainage of tubo-ovarian abscesses using endosonographically placed LAMS is a safe and effective technique and should be considered a primary alternative to surgical or percutaneous interventions.