EUS Guided Drainage in the Treatment of Pelvic Abscesses: A Case Series

Abstract: Background: Pelvic abscesses, particularly those in deep supralevator or perirectal locations, pose significant therapeutic challenges when traditional drainage approaches are contraindicated or technically unfeasible. This study aims to evaluate the safety and efficacy of endoscopic ultrasound (EUS)-guided transrectal drainage of pelvic abscesses using lumen-apposing metal stents (LAMS), with or without coaxial plastic stents. Methods: This retrospective case series includes six patients who underwent EUS-guided drainage across three hospitals from May 2020 to May 2024. All patients had symptomatic pelvic abscesses not amenable to image-guided percutaneous drainage, confirmed by cross-sectional imaging. Interventions were performed using a linear-array echoendoscope and the electrocautery-enhanced Hot AXIOS™ LAMS system. A 7 Fr × 3 cm double pigtail plastic stent was placed coaxially in four patients to enhance drainage. Data collected included patient demographics, abscess characteristics, procedural details, clinical outcomes, and adverse events. Results: Technical success was achieved in all six cases (100%). The average initial abscess size was 5.65 × 4.62 cm (range: 4.0–8.2 cm). Clinical resolution, defined by symptom improvement and radiologic confirmation of cavity collapse (<2 cm), occurred in all patients. Median stent indwelling time was four weeks. No major complications (bleeding, stent migration, perforation, or infection) were observed. Minor self-limited pelvic pain was reported in two patients. No patients required surgical intervention or experienced abscess recurrence during follow-up. Conclusions: EUS-guided transrectal drainage using LAMS, with optional coaxial plastic stenting, is a safe and effective alternative for managing pelvic abscesses in patients not suitable for percutaneous drainage. These findings support its growing role in multidisciplinary abscess management and highlight its utility in high-risk or anatomically challenging cases.