EUS-Guided Drainage for Pelvic Abscesses: A Chinese Single-Center Two-year Follow-up Study Highlighting Clinical Outcomes

EUS-Guided Drainage for Pelvic Abscesses: A Chinese Single-Center Two-year Follow-up Study Highlighting Clinical Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article EUS-Guided Drainage for Pelvic Abscesses: A Chinese Single-Center Two-year Follow-up Study Highlighting Clinical Outcomes Tao Yang, Yi Lu, Wenru Li, Jun Deng, Tao Liu, Yanan Liu, Ming Zhi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6586999/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 May, 2026 Read the published version in BMC Gastroenterology → Version 1 posted 10 You are reading this latest preprint version Abstract Background and Aim of Study Endoscopic ultrasound (EUS)- guided drainage has emerged as a novel technique for managing pelvic abscesses. This single-center retrospective study aims to assess the safety and efficacy of EUS-guided drainage in treating pelvic abscesses of varying etiologies from 2021 to the present. Patients and Methods Consecutive patients with pelvic abscesses who underwent EUS-guided drainage were retrospectively reviewed. Etiologies included appendiceal abscess secondary to acute appendicitis (n = 1), pelvic abscesses resulting from anastomotic leaks following rectal cancer surgery (n = 2), and perianal abscesses associated with Crohn's disease (n = 7). The primary outcome was technical success and reduction in abscess cavity size, assessed via follow-up imaging. Secondary outcomes included post-procedural complications and resolution of the abscess without additional interventions. Results EUS-guided drainage was technically successful in all cases. The median reduction in abscess size was statistically significant (Mean SD: 24.1 ± 11.11, p < 0.05). During follow-up, imaging results confirmed significantly reduced in size of pelvic abscesses in 9 patients, except for one case at the 1-month post-procedure. None of the patients required further surgical intervention, and 2 cases recurrences were observed in the sixth- and tenth-months post-treatment. Additionally, no procedure-related complications were reported. Conclusion EUS-guided drainage is a safe and effective therapeutic option for managing pelvic abscesses of various etiologies. Its efficacy, particularly in Crohn's disease-related cases, and the absence of complications in this cohort, suggest significant potential for broader clinical application. Figures Figure 1 Figure 2 Introduction Pelvic abscesses represent a significant clinical challenge, frequently arising as complications following colorectal or gynecological surgery or in association with various conditions such as perforated viscus, Crohn's disease (CD), appendicitis, diverticulitis, ischemic colitis, endocarditis, and sexually transmitted infections [ 1 ]. These abscesses were associated with substantial morbidity and mortality, underscoring the importance of developing effective therapeutic strategies [ 2 ]. Historically, surgical intervention has been the primary treatment modality, particularly in cases of perforation or failure of minimally invasive techniques. However, noninvasive approaches have increasingly gained acceptance as first-line treatments [ 3 ]. Among these, ultrasound-guided drainage has demonstrated high success rates, although its utility is restricted to abscesses that are accessible to an ultrasound probe. Computed tomography (CT)-guided percutaneous drainage provided an alternative for deep pelvic collections but carried limitations, including puncture site pain and the inability to place transmural stents, often necessitating the use of uncomfortable and potentially painful drainage catheters [ 4 – 6 ]. The technical challenges associated with the drainage of deep pelvic collections are further complicated by the presence of surrounding anatomical and vascular structures. Endoscopic ultrasound (EUS) presents a distinct advantage in such cases, as it allowed for direct access to the abscess without traversing other organs, given that most pelvic abscesses were within the reach of an echoendoscope [ 7 ]. Over the past decade, several case series had highlighted the safety and efficacy of EUS-guided drainage for pelvic abscesses [ 8 , 9 ]. However, large-scale or multicenter studies remain limited. In this context, the present study documents a single-center experience in China, focusing on the management of pelvic abscesses through EUS-guided drainage from 2021 to the present. The study cohort comprises 10 cases of pelvic abscesses, with etiologies including appendicitis, postoperative complications of rectal cancer surgery, and Crohn's disease-associated perianal abscesses. This investigation aims to contribute to the expanding body of evidence supporting EUS-guided drainage as a minimally invasive and effective alternative to surgery for managing pelvic abscesses, while also providing insights into its application within a Chinese population. Methods This study was a retrospective, single-center case series conducted at a tertiary care center in China between January 2021 and December 2023. The study included 10 consecutive patients with pelvic abscesses who were referred for endoscopic ultrasound (EUS)-guided drainage. Inclusion criteria required that patients have intra-abdominal or pelvic abscesses located within 3 cm of the intestinal wall and measuring at least 2 cm in size. Patients were selected if they were unable to undergo effective drainage via ultrasound or computed tomography (CT) guidance. Exclusion criteria included individuals with coagulation disorders, those unable to tolerate the procedure due to cardiac or pulmonary comorbidities, individuals with gastrointestinal perforation, and those with malignant abscesses that could potentially disseminate. This selection process ensured a homogeneous patient population suitable for evaluating the efficacy of alternative drainage methods. All patients underwent a pelvic computed tomography scan before the procedure to determine the precise size and location of the abscess. Abscesses were classified as either perirectal or pericolonic. Perirectal abscesses were defined as those located within 10 cm of the anal verge, while pericolonic abscesses were defined as those within 20 cm of the anal verge. Patients underwent bowel preparation with polyethylene glycol before the procedure. All patients were receiving systemic antibiotics (either ceftriaxone or metronidazole) at the time of the procedure, and these antibiotics were continued for five days post-procedure. In all cases, repeat pelvic CT imaging or pelvic Magnetic Resonance (MR) imaging was performed one month after the procedure to assess the outcome. Additionally, all patients underwent clinical follow-up to evaluate the long-term resolution of the abscess. Informed consent was obtained from all patients before undergoing EUS-guided drainage. Procedure The pelvic abscess was identified using a linear-array echoendoscope (GF-UCT240-AL5; Olympus, Tokyo, Japan), which was employed to assess the abscess’s location, size, and anatomical relationship with surrounding structures. Color Doppler ultrasound was utilized to select a safe puncture site, ensuring avoidance of any intervening blood vessels. A 19-gauge needle (ECHO-HD-19-A; Cook Ireland Limited, Limerick, Ireland) was used to puncture the abscess cavity, and the contents were aspirated using a 10-mL syringe. The aspirated material was sent for Gram staining and microbiological culture to guide appropriate antibiotic therapy. For smaller abscesses (< 3 cm in diameter), if the initial aspiration did not yield any fluid, the abscess cavity was flushed with a metronidazole sodium chloride solution to facilitate further aspiration (Fig. 1 ). For larger abscesses (≥ 3 cm in diameter), a 0.035-inch guidewire (MO0556581; Boston Scientific Corporation, Marlborough, USA) was introduced into the cavity. This was followed by the creation of a fistulous tract using a cystotome (CST-10; Cook Ireland Limited, Limerick, Ireland). To ensure proper drainage, double-pigtail plastic stents (ZSS-10-3-RB; Cook Ireland Limited, Limerick, Ireland) were deployed through the fistulous tract into the abscess cavity under combined endoscopic and fluoroscopic guidance (Fig. 2 ). The correct placement of the stents and the subsequent resolution of the abscess were confirmed through follow-up imaging. Post-operative and Long-term Follow-up In the immediate postoperative period, all 10 patients were closely monitored for pain and signs of sepsis, including fever. Biological ers, such as C-reactive protein (CRP) levels and white blood cell (WBC) counts, were assessed within one-week post-procedure to evaluate the inflammatory response. Each patient underwent an CT or MRI at one-month post-procedure to assess the regression of the abscess. Complications were categorized as either major or minor. Major complications included severe sepsis, perforations, or hemorrhage requiring endoscopic intervention or blood transfusion. Minor complications included fever without hypotension, self-limited bleeding, and stent migration. Long-term success was defined as the complete resolution of the abscess without the need for subsequent surgical intervention and the absence of recurrence during follow-up. Long-term follow-up data were obtained from medical records, clinical follow-up visits with the endoscopist, surgeon, or Internal Medicine Physician, and through direct communication with patients or their referring physicians via telephone. The follow-up period commenced on the day of EUS-guided drainage (Day 0) and concluded on the date of either a complication or recurrence necessitating surgical drainage or the last known date of patient contact. Statistical Analysis Postoperative and long-term follow-up data for the 10 patients who underwent EUS-guided drainage for pelvic abscesses were analyzed using SPSS Statistics software (IBM, Rochester, Minnesota, USA). Data were presented as averages, along with ranges and percentages where appropriate. Frequencies and percentages were used to describe qualitative variables, while median, mean, and quartiles were applied to quantitative variables. For comparisons involving the reduction in abscess size, changes in CRP levels, and WBC counts, a Student’s t-test was employed. A p-value of less than 0.05 was considered statistically significant for all analyses [ 10 ]. Results Patient Characteristics and Etiology of Pelvic Abscess In this study, 10 patients with symptomatic pelvic abscesses were included. The mean age was 37.7 years, ranging from 21 to 66 years, with 70% male patients. The etiology of pelvic abscesses is detailed in Table 1 , with Crohn's disease being the most prevalent cause, accounting for 70% of cases. Other causes included appendicitis and postoperative leaks following rectal cancer surgery. Table 1 Patient characteristics and causes of pelvic abscess Patients n Age, mean (range), years 37.7(21–66) Sex, n (%) Male 7(70%) Female 3(30%) Location of abscess Anterior rectal wall 6(60%) Posterior rectal wall 4(40%) Underlying pathology Appendicitis 1(10%) Leakage after rectal cancer surgery 2(20%) Crohn's disease 7(70%) Clinical Features and Outcomes of EUS-Guided Drainage Table 2 presents the clinical features and outcomes of patients undergoing endoscopic ultrasound (EUS)-guided drainage of pelvic abscesses. Under CT or MR evaluation, the technical success rate of EUS-guided drainage was 90% in the first month with all procedures successfully reducing the abscess cavity. Except for one patient who did not decrease in size in the first month, no patients experienced adverse events related to the procedure, and there were no procedure-related deaths. During a median follow-up period of 20 months (range, 3 to 31), two cases of recurrence were observed at the sixth- and tenth-months post-treatment. Table 2 Clinical features and outcomes in patients undergoing endoscopic ultrasound (EUS)-guided drainage of pelvic abscesses No Abscess location Etiology Abscess size (mm) Procedure Complication Follow-up 1-month post MRI/CT Follow-up period(month) Recurrence 1 Anterior Appendicitis 62 Puncture, antibiotic irrigation, Stenting no Diminish 3 No 2 Anterior Crohn's disease 33 Puncture, antibiotic irrigation no Diminish 13 10 months Post 3 Posterior Leaks after rectal cancer surgery 24 Puncture, antibiotic irrigation no Diminish 4 No 4 Anterior Crohn's disease 31 Puncture, antibiotic irrigation no Diminish 31 No 5 Anterior Crohn's disease 19 Puncture, antibiotic irrigation no Diminish 8 No 6 Posterior Crohn's disease 25 Puncture, antibiotic irrigation no Diminish 30 No 7 Anterior Crohn's disease 28 Puncture, antibiotic irrigation no Diminish 28 No 8 Anterior Crohn's disease 44 Puncture, antibiotic irrigation no Diminish 26 6 months Post 9 Posterior Leaks after rectal cancer surgery 37 Puncture, antibiotic irrigation no Diminish 24 No 10 Posterior Crohn's disease 20 Puncture, antibiotic irrigation no No Diminish 16 No Infection Marker and Abscess Size Variations A comprehensive analysis of infection markers and abscess size changes was conducted during the intervention. Table 3 provides detailed data on variations observed one month before and after surgery and one week before and after surgery. Results demonstrate a significant reduction in abscess size following surgical intervention (p < 0.001). Although a noticeable decrease in infection markers was observed before and after surgery, the differences were not statistically significant. Table 3 Marker of infection and abscess size records during intervention periods Preoperative Median (95%CI) Postoperative Median (95%CI) P 3 Size of pelvic abscess by EUS 1 29.5(23.02–41.57) 7.00(1.39–15.01) <0.001* C-reactive protein 2 73.28(32.25-135.33) 5.98(-8.8-85.22) 0.053 White blood cell count (WBC) 2 8.88(6.16–13.45) 7.26(6.10–8.54) 0.145 1 Records of one month before and after surgery 2 Records of one week before and after surgery 3 Student's t-test. *Statistically significant Discussion Our study, involving a cohort of 10 patients who underwent endoscopic ultrasound (EUS)-)-guided drainage for pelvic abscesses, adds to the existing body of evidence supporting the safety and efficacy of this minimally invasive technique. Achieving a technical success rate of 100% and a clinical success rate of 90% at the 4-week follow-up, our findings are consistent with, and in some respects exceed, those reported in the literature, including the largest series by Poincloux L et al., which documented a clinical success rate of 91.9% [ 11 ]. Our findings support the use of endoscopic ultrasound (EUS)-guided drainage for pelvic abscesses secondary to medical conditions, including CD. Despite initial concerns about permanent internal fistula formation, our CD patients did not experience procedure-related complications. It is well documented that the abscess in CD patients is often associated with active inflammation [ 12 , 13 ]. This inflammation may be a contributing factor to the persistence of the abscess, suggesting that the timing of the intervention should ideally coincide with a period of reduced disease activity. If inflammation is not adequately controlled, there is a heightened risk of abscess recurrence even after drainage procedures [ 14 ]. Therefore, managing CD-related abscesses may require a more nuanced approach that considers the disease's inflammatory activity. The incidence of postoperative pelvic abscesses, particularly following colorectal surgery, remains significant, with rates up to 15% as indicated by recent observational studies [ 15 , 16 ]. This study illustrates that EUS-guided drainage is not only a feasible alternative to surgical intervention but also provides favorable long-term outcomes, particularly advantageous for patients who are often in poor general health and at elevated risk for surgical complications. Postsurgical colorectal abscesses accounted for 65% of cases in our study, reflecting common clinical scenarios and underscoring the relevance of our findings. A significant observation in our study is the absence of major complications and the minimal nature of those that did occur, such as self-limited bleeding and stent migration, which were managed conservatively. This underscores the procedure's overall safety and aligns with previous studies reporting low complication rates associated with EUS-guided drainage [ 17 , 18 ]. Our approach with EUS-guided drainage has evolved, leading to technical refinements. We employed the method described by Giovannini et al., which is efficient and straightforward [ 19 ]. We utilized metronidazole sodium chloride solution instead of normal saline for flushing small abscesses, potentially enhancing infection control. For abscesses larger than 6 cm, placing an additional flushing catheter for several days was advocated to mitigate clogging and stent migration risks. This study provides valuable insights into the application of EUS-guided drainage for pelvic abscesses. However, its retrospective nature, lack of comparative analysis with other drainage methods, and small sample size present limitations that necessitate cautious interpretation of the results. Future research with larger cohorts and a prospective design, including comparisons with alternative drainage techniques, is necessary to further elucidate the role of EUS-guided drainage in clinical practice. In conclusion, our study demonstrates that EUS-guided drainage is a safe and effective procedure for pelvic abscesses, offering favorable long-term outcomes and serving as a viable alternative to percutaneous or surgical drainage methods. Notably, the procedure's efficacy extends beyond postoperative complications, addressing abscesses arising from medical conditions such as Crohn's disease. Contrary to initial concerns, our findings alleviate fears of permanent internal fistula formation, indicating that EUS-guided drainage is well-tolerated in Crohn's disease patients without associated complications. This broadens the potential applications of EUS-guided drainage in managing pelvic abscesses, highlighting its utility in diverse clinical scenarios. Declarations Funding This study was supported by The Sixth Affiliated Hospital of Sun Yat-Sen University Clinical Research- “1010” Program (Grant No. 1010PY(2022)-16) and Guangdong Province Health Appropriate Technology Promotion Program (Grant No. 202303191848544579). Data availability Data used in this study are available from the corresponding authors upon reasonable request. Acknowledgments Supported by the program of Guangdong Provincial Clinical Research Center for Digestive Diseases (2020B1111170004). Ethics approval and consent to participate This study was conducted based on the ethical principles of the Declaration of Helsinki 1964. The study was approved by the Institutional Review Board (IRB) of The Sixth Affiliated Hospital, Sun Yat-sen University (approval No. E2024338). The IRB waived the requirement of written informed consent for participation from the participants or the participants’ legal guardians/next of kin because this was a retrospective study, and was observational, the patients’ data were kept privacy. Consent for publication Not applicable. Author contributions Study concept and design: Tao Yang, Yi Lu Acquisition of data: Tao Yang Radiographic evaluation: Wenru Li Analysis and interpretation: Jun Deng, Tao Liu, Study supervision: Yanan Liu, Ming Zhi, Jiachen Sun Disclosure statement The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. References Benigno BB. 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Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 02 May, 2026 Read the published version in BMC Gastroenterology → Version 1 posted Editorial decision: Revision requested 25 Nov, 2025 Reviews received at journal 01 Jun, 2025 Reviews received at journal 16 May, 2025 Reviewers agreed at journal 15 May, 2025 Reviewers agreed at journal 14 May, 2025 Reviewers invited by journal 13 May, 2025 Editor assigned by journal 13 May, 2025 Editor invited by journal 12 May, 2025 Submission checks completed at journal 09 May, 2025 First submitted to journal 09 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6586999","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":457044702,"identity":"f1ee3858-f87d-418a-9031-89824df290a7","order_by":0,"name":"Tao Yang","email":"","orcid":"","institution":"Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Yang","suffix":""},{"id":457044703,"identity":"6b7d49f5-7b58-44ad-82c3-17fd6093f2ff","order_by":1,"name":"Yi Lu","email":"","orcid":"","institution":"Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Lu","suffix":""},{"id":457044708,"identity":"b6b80e59-96d4-40e3-8fbe-0dcf67a3fe57","order_by":2,"name":"Wenru Li","email":"","orcid":"","institution":"Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Wenru","middleName":"","lastName":"Li","suffix":""},{"id":457044710,"identity":"7d479fc6-bf09-4bf9-ac22-a3fce0e91971","order_by":3,"name":"Jun Deng","email":"","orcid":"","institution":"Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Jun","middleName":"","lastName":"Deng","suffix":""},{"id":457044711,"identity":"0dd44d64-4087-480c-96c9-823aa55d066a","order_by":4,"name":"Tao Liu","email":"","orcid":"","institution":"Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Liu","suffix":""},{"id":457044713,"identity":"3856a4ed-04d6-4d31-8a52-fc4b967bdeb9","order_by":5,"name":"Yanan Liu","email":"","orcid":"","institution":"Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Yanan","middleName":"","lastName":"Liu","suffix":""},{"id":457044722,"identity":"6fce8658-9c7e-4a04-980a-f6ac434bb521","order_by":6,"name":"Ming Zhi","email":"","orcid":"","institution":"Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Ming","middleName":"","lastName":"Zhi","suffix":""},{"id":457044724,"identity":"e7a14315-af24-4b04-97c0-d7c98e156e65","order_by":7,"name":"Jiachen Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYJACA8YGGzkGBsbGAzARCSK0pBkDtTQQrwWo+HBiA5AmTov8jNwDBT93pKWvbT8MtOXPYXuDA8wHb/Mw2OXhdNSNvATD3jM2udvOJDYcYGw7nLjhAFuyNQ9DcjFOLRI5BsaMbWm52w6AtDQcTjA4wGMmzcNwAOxU7A4Dazmcbnb+Icxh/N/wamG4AdGSYHYDaAsD22HGDQd42PBqMTjzxsCwty3NcNsNoC2JbemJMw+zGVvOMUjG7bD2HDODn2028mbn0x8++PDH2p7vePPDG28q7HA7jIGBzQDOTGBoZmBgBtuOWz0QMD9A4tThVToKRsEoGAUjEwAAY4ZfyCfH1X0AAAAASUVORK5CYII=","orcid":"","institution":"Sixth Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":true,"prefix":"","firstName":"Jiachen","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2025-05-04 06:53:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6586999/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6586999/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12876-026-04741-5","type":"published","date":"2026-05-02T15:57:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83016714,"identity":"9669c9fe-e4a9-40fa-99a9-e2cc704b0fcb","added_by":"auto","created_at":"2025-05-19 06:33:08","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":286274,"visible":true,"origin":"","legend":"\u003cp\u003eEUS-guided drainage for smaller pelvic abscesses. A. Coronal pelvic MRI shows pelvic abscess (red arrow). B. Transverse pelvic MRI shows pelvic abscess (red arrow). C. EUS shows pelvic abscess (blue arrow) and no blood vessels in the puncture approach. D. Puncture needle is inserted into pelvic abscess under the guidance of EUS (green arrow). E. Coronal pelvic MRI shows disappearance of abscess 18 months later (yellow arrow). F. Transverse pelvic MRI shows disappearance of abscess 18 months later (yellow arrow).\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6586999/v1/076c1f9fe3dc5091b7d1aa06.jpeg"},{"id":83016719,"identity":"c44f2e4e-d785-413d-872d-6a398c8a326b","added_by":"auto","created_at":"2025-05-19 06:33:08","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":269962,"visible":true,"origin":"","legend":"\u003cp\u003eEUS-guided drainage for lager pelvic abscesses. A. Intestinal ultrasound shows pelvic abscess (red arrow). B. Transverse pelvic MRI shows pelvic abscess (red arrow). C. EUS shows pelvic abscess and no blood vessels in the puncture approach. D. Puncture needle is inserted into pelvic abscess under the guidance of EUS. E. Fistulous tract is created by a cystotome. F. Double-pigtail plastic stents are deployed through the fistulous tract into the abscess cavity. G. Intestinal ultrasound shows significant reduction in pelvic abscess size one week later (yellow arrow). H. Intestinal ultrasound shows that pelvic abscess had almost disappeared five weeks later (yellow arrow).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6586999/v1/fe2385ef144dfff550db12b5.jpeg"},{"id":108495383,"identity":"60323ff8-45d2-4b1f-af4d-a6bcf4f85abe","added_by":"auto","created_at":"2026-05-05 10:09:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":811868,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6586999/v1/b50d51e4-dc7a-4b39-b797-68c2c734448a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"EUS-Guided Drainage for Pelvic Abscesses: A Chinese Single-Center Two-year Follow-up Study Highlighting Clinical Outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePelvic abscesses represent a significant clinical challenge, frequently arising as complications following colorectal or gynecological surgery or in association with various conditions such as perforated viscus, Crohn's disease (CD), appendicitis, diverticulitis, ischemic colitis, endocarditis, and sexually transmitted infections [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These abscesses were associated with substantial morbidity and mortality, underscoring the importance of developing effective therapeutic strategies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Historically, surgical intervention has been the primary treatment modality, particularly in cases of perforation or failure of minimally invasive techniques. However, noninvasive approaches have increasingly gained acceptance as first-line treatments [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong these, ultrasound-guided drainage has demonstrated high success rates, although its utility is restricted to abscesses that are accessible to an ultrasound probe. Computed tomography (CT)-guided percutaneous drainage provided an alternative for deep pelvic collections but carried limitations, including puncture site pain and the inability to place transmural stents, often necessitating the use of uncomfortable and potentially painful drainage catheters [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe technical challenges associated with the drainage of deep pelvic collections are further complicated by the presence of surrounding anatomical and vascular structures. Endoscopic ultrasound (EUS) presents a distinct advantage in such cases, as it allowed for direct access to the abscess without traversing other organs, given that most pelvic abscesses were within the reach of an echoendoscope [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Over the past decade, several case series had highlighted the safety and efficacy of EUS-guided drainage for pelvic abscesses [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, large-scale or multicenter studies remain limited.\u003c/p\u003e \u003cp\u003e In this context, the present study documents a single-center experience in China, focusing on the management of pelvic abscesses through EUS-guided drainage from 2021 to the present. The study cohort comprises 10 cases of pelvic abscesses, with etiologies including appendicitis, postoperative complications of rectal cancer surgery, and Crohn's disease-associated perianal abscesses. This investigation aims to contribute to the expanding body of evidence supporting EUS-guided drainage as a minimally invasive and effective alternative to surgery for managing pelvic abscesses, while also providing insights into its application within a Chinese population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study was a retrospective, single-center case series conducted at a tertiary care center in China between January 2021 and December 2023. The study included 10 consecutive patients with pelvic abscesses who were referred for endoscopic ultrasound (EUS)-guided drainage. Inclusion criteria required that patients have intra-abdominal or pelvic abscesses located within 3 cm of the intestinal wall and measuring at least 2 cm in size. Patients were selected if they were unable to undergo effective drainage via ultrasound or computed tomography (CT) guidance. Exclusion criteria included individuals with coagulation disorders, those unable to tolerate the procedure due to cardiac or pulmonary comorbidities, individuals with gastrointestinal perforation, and those with malignant abscesses that could potentially disseminate. This selection process ensured a homogeneous patient population suitable for evaluating the efficacy of alternative drainage methods.\u003c/p\u003e \u003cp\u003eAll patients underwent a pelvic computed tomography scan before the procedure to determine the precise size and location of the abscess. Abscesses were classified as either perirectal or pericolonic. Perirectal abscesses were defined as those located within 10 cm of the anal verge, while pericolonic abscesses were defined as those within 20 cm of the anal verge. Patients underwent bowel preparation with polyethylene glycol before the procedure. All patients were receiving systemic antibiotics (either ceftriaxone or metronidazole) at the time of the procedure, and these antibiotics were continued for five days post-procedure.\u003c/p\u003e \u003cp\u003eIn all cases, repeat pelvic CT imaging or pelvic Magnetic Resonance (MR) imaging was performed one month after the procedure to assess the outcome. Additionally, all patients underwent clinical follow-up to evaluate the long-term resolution of the abscess. Informed consent was obtained from all patients before undergoing EUS-guided drainage.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eThe pelvic abscess was identified using a linear-array echoendoscope (GF-UCT240-AL5; Olympus, Tokyo, Japan), which was employed to assess the abscess\u0026rsquo;s location, size, and anatomical relationship with surrounding structures. Color Doppler ultrasound was utilized to select a safe puncture site, ensuring avoidance of any intervening blood vessels. A 19-gauge needle (ECHO-HD-19-A; Cook Ireland Limited, Limerick, Ireland) was used to puncture the abscess cavity, and the contents were aspirated using a 10-mL syringe. The aspirated material was sent for Gram staining and microbiological culture to guide appropriate antibiotic therapy.\u003c/p\u003e \u003cp\u003eFor smaller abscesses (\u0026lt;\u0026thinsp;3 cm in diameter), if the initial aspiration did not yield any fluid, the abscess cavity was flushed with a metronidazole sodium chloride solution to facilitate further aspiration (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). For larger abscesses (\u0026ge;\u0026thinsp;3 cm in diameter), a 0.035-inch guidewire (MO0556581; Boston Scientific Corporation, Marlborough, USA) was introduced into the cavity. This was followed by the creation of a fistulous tract using a cystotome (CST-10; Cook Ireland Limited, Limerick, Ireland).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo ensure proper drainage, double-pigtail plastic stents (ZSS-10-3-RB; Cook Ireland Limited, Limerick, Ireland) were deployed through the fistulous tract into the abscess cavity under combined endoscopic and fluoroscopic guidance (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The correct placement of the stents and the subsequent resolution of the abscess were confirmed through follow-up imaging.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePost-operative and Long-term Follow-up\u003c/h3\u003e\n\u003cp\u003eIn the immediate postoperative period, all 10 patients were closely monitored for pain and signs of sepsis, including fever. Biological ers, such as C-reactive protein (CRP) levels and white blood cell (WBC) counts, were assessed within one-week post-procedure to evaluate the inflammatory response. Each patient underwent an CT or MRI at one-month post-procedure to assess the regression of the abscess.\u003c/p\u003e \u003cp\u003eComplications were categorized as either major or minor. Major complications included severe sepsis, perforations, or hemorrhage requiring endoscopic intervention or blood transfusion. Minor complications included fever without hypotension, self-limited bleeding, and stent migration.\u003c/p\u003e \u003cp\u003eLong-term success was defined as the complete resolution of the abscess without the need for subsequent surgical intervention and the absence of recurrence during follow-up. Long-term follow-up data were obtained from medical records, clinical follow-up visits with the endoscopist, surgeon, or Internal Medicine Physician, and through direct communication with patients or their referring physicians via telephone. The follow-up period commenced on the day of EUS-guided drainage (Day 0) and concluded on the date of either a complication or recurrence necessitating surgical drainage or the last known date of patient contact.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003ePostoperative and long-term follow-up data for the 10 patients who underwent EUS-guided drainage for pelvic abscesses were analyzed using SPSS Statistics software (IBM, Rochester, Minnesota, USA). Data were presented as averages, along with ranges and percentages where appropriate. Frequencies and percentages were used to describe qualitative variables, while median, mean, and quartiles were applied to quantitative variables. For comparisons involving the reduction in abscess size, changes in CRP levels, and WBC counts, a Student\u0026rsquo;s t-test was employed. A p-value of less than 0.05 was considered statistically significant for all analyses [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePatient Characteristics and Etiology of Pelvic Abscess\u003c/h2\u003e \u003cp\u003eIn this study, 10 patients with symptomatic pelvic abscesses were included. The mean age was 37.7 years, ranging from 21 to 66 years, with 70% male patients. The etiology of pelvic abscesses is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, with Crohn's disease being the most prevalent cause, accounting for 70% of cases. Other causes included appendicitis and postoperative leaks following rectal cancer surgery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics and causes of pelvic abscess\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (range), years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.7(21\u0026ndash;66)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(30%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation of abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnterior rectal wall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(60%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosterior rectal wall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(40%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnderlying pathology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAppendicitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeakage after rectal cancer surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(20%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(70%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eClinical Features and Outcomes of EUS-Guided Drainage\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the clinical features and outcomes of patients undergoing endoscopic ultrasound (EUS)-guided drainage of pelvic abscesses. Under CT or MR evaluation, the technical success rate of EUS-guided drainage was 90% in the first month with all procedures successfully reducing the abscess cavity. Except for one patient who did not decrease in size in the first month, no patients experienced adverse events related to the procedure, and there were no procedure-related deaths. During a median follow-up period of 20 months (range, 3 to 31), two cases of recurrence were observed at the sixth- and tenth-months post-treatment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical features and outcomes in patients undergoing endoscopic ultrasound (EUS)-guided drainage of pelvic abscesses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAbscess location\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAbscess size (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComplication\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eFollow-up\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1-month post MRI/CT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFollow-up period(month)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eRecurrence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAppendicitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation, Stenting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10 months Post\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeaks after rectal cancer surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6 months Post\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeaks after rectal cancer surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDiminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePosterior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrohn's disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePuncture, antibiotic irrigation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo Diminish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInfection Marker and Abscess Size Variations\u003c/h3\u003e\n\u003cp\u003eA comprehensive analysis of infection markers and abscess size changes was conducted during the intervention. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides detailed data on variations observed one month before and after surgery and one week before and after surgery. Results demonstrate a significant reduction in abscess size following surgical intervention (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Although a noticeable decrease in infection markers was observed before and after surgery, the differences were not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMarker of infection and abscess size records during intervention periods\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003cp\u003eMedian (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePostoperative\u003c/p\u003e \u003cp\u003eMedian (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize of pelvic abscess by EUS\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29.5(23.02\u0026ndash;41.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.00(1.39\u0026ndash;15.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC-reactive protein\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73.28(32.25-135.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.98(-8.8-85.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite blood cell count (WBC)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8.88(6.16\u0026ndash;13.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.26(6.10\u0026ndash;8.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e1 Records of one month before and after surgery\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e2 Records of one week before and after surgery\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e3 Student's t-test.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*Statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study, involving a cohort of 10 patients who underwent endoscopic ultrasound (EUS)-)-guided drainage for pelvic abscesses, adds to the existing body of evidence supporting the safety and efficacy of this minimally invasive technique. Achieving a technical success rate of 100% and a clinical success rate of 90% at the 4-week follow-up, our findings are consistent with, and in some respects exceed, those reported in the literature, including the largest series by Poincloux L et al., which documented a clinical success rate of 91.9% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur findings support the use of endoscopic ultrasound (EUS)-guided drainage for pelvic abscesses secondary to medical conditions, including CD. Despite initial concerns about permanent internal fistula formation, our CD patients did not experience procedure-related complications.\u003c/p\u003e \u003cp\u003eIt is well documented that the abscess in CD patients is often associated with active inflammation [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. This inflammation may be a contributing factor to the persistence of the abscess, suggesting that the timing of the intervention should ideally coincide with a period of reduced disease activity. If inflammation is not adequately controlled, there is a heightened risk of abscess recurrence even after drainage procedures [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, managing CD-related abscesses may require a more nuanced approach that considers the disease's inflammatory activity.\u003c/p\u003e \u003cp\u003eThe incidence of postoperative pelvic abscesses, particularly following colorectal surgery, remains significant, with rates up to 15% as indicated by recent observational studies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This study illustrates that EUS-guided drainage is not only a feasible alternative to surgical intervention but also provides favorable long-term outcomes, particularly advantageous for patients who are often in poor general health and at elevated risk for surgical complications. Postsurgical colorectal abscesses accounted for 65% of cases in our study, reflecting common clinical scenarios and underscoring the relevance of our findings.\u003c/p\u003e \u003cp\u003eA significant observation in our study is the absence of major complications and the minimal nature of those that did occur, such as self-limited bleeding and stent migration, which were managed conservatively. This underscores the procedure's overall safety and aligns with previous studies reporting low complication rates associated with EUS-guided drainage [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Our approach with EUS-guided drainage has evolved, leading to technical refinements. We employed the method described by Giovannini et al., which is efficient and straightforward [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. We utilized metronidazole sodium chloride solution instead of normal saline for flushing small abscesses, potentially enhancing infection control. For abscesses larger than 6 cm, placing an additional flushing catheter for several days was advocated to mitigate clogging and stent migration risks.\u003c/p\u003e \u003cp\u003e This study provides valuable insights into the application of EUS-guided drainage for pelvic abscesses. However, its retrospective nature, lack of comparative analysis with other drainage methods, and small sample size present limitations that necessitate cautious interpretation of the results. Future research with larger cohorts and a prospective design, including comparisons with alternative drainage techniques, is necessary to further elucidate the role of EUS-guided drainage in clinical practice.\u003c/p\u003e \u003cp\u003eIn conclusion, our study demonstrates that EUS-guided drainage is a safe and effective procedure for pelvic abscesses, offering favorable long-term outcomes and serving as a viable alternative to percutaneous or surgical drainage methods. Notably, the procedure's efficacy extends beyond postoperative complications, addressing abscesses arising from medical conditions such as Crohn's disease. Contrary to initial concerns, our findings alleviate fears of permanent internal fistula formation, indicating that EUS-guided drainage is well-tolerated in Crohn's disease patients without associated complications. This broadens the potential applications of EUS-guided drainage in managing pelvic abscesses, highlighting its utility in diverse clinical scenarios.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by The Sixth Affiliated Hospital of Sun Yat-Sen University Clinical Research- “1010” Program (Grant No. 1010PY(2022)-16) and Guangdong Province Health Appropriate Technology Promotion Program (Grant No. 202303191848544579).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used in this study are available from the corresponding authors upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupported by the program of Guangdong Provincial Clinical Research Center for Digestive Diseases (2020B1111170004).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted based on the ethical principles of the Declaration of Helsinki 1964. The study was approved by the Institutional Review Board (IRB) of The Sixth Affiliated Hospital, Sun Yat-sen University (approval No. E2024338). The IRB waived the requirement of written informed consent for participation from the participants or the participants’ legal guardians/next of kin because this was a retrospective study, and was observational, the patients’ data were kept privacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy concept and design: Tao Yang, Yi Lu\u003c/p\u003e\n\u003cp\u003eAcquisition of data: Tao Yang\u003c/p\u003e\n\u003cp\u003eRadiographic evaluation: Wenru Li\u003c/p\u003e\n\u003cp\u003eAnalysis and interpretation: Jun Deng, Tao Liu,\u003c/p\u003e\n\u003cp\u003eStudy supervision: Yanan Liu, Ming Zhi, Jiachen Sun\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBenigno BB. 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Endoscopy. 2003;35:511\u0026ndash;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1055/s-2003-40248\u003c/span\u003e\u003cspan address=\"10.1055/s-2003-40248\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6586999/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6586999/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground and Aim of Study\u003c/h2\u003e \u003cp\u003eEndoscopic ultrasound (EUS)- guided drainage has emerged as a novel technique for managing pelvic abscesses. This single-center retrospective study aims to assess the safety and efficacy of EUS-guided drainage in treating pelvic abscesses of varying etiologies from 2021 to the present.\u003c/p\u003e\u003ch2\u003ePatients and Methods\u003c/h2\u003e \u003cp\u003eConsecutive patients with pelvic abscesses who underwent EUS-guided drainage were retrospectively reviewed. Etiologies included appendiceal abscess secondary to acute appendicitis (n\u0026thinsp;=\u0026thinsp;1), pelvic abscesses resulting from anastomotic leaks following rectal cancer surgery (n\u0026thinsp;=\u0026thinsp;2), and perianal abscesses associated with Crohn's disease (n\u0026thinsp;=\u0026thinsp;7). The primary outcome was technical success and reduction in abscess cavity size, assessed via follow-up imaging. Secondary outcomes included post-procedural complications and resolution of the abscess without additional interventions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eEUS-guided drainage was technically successful in all cases. The median reduction in abscess size was statistically significant (Mean SD: 24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.11, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). During follow-up, imaging results confirmed significantly reduced in size of pelvic abscesses in 9 patients, except for one case at the 1-month post-procedure. None of the patients required further surgical intervention, and 2 cases recurrences were observed in the sixth- and tenth-months post-treatment. Additionally, no procedure-related complications were reported.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEUS-guided drainage is a safe and effective therapeutic option for managing pelvic abscesses of various etiologies. Its efficacy, particularly in Crohn's disease-related cases, and the absence of complications in this cohort, suggest significant potential for broader clinical application.\u003c/p\u003e","manuscriptTitle":"EUS-Guided Drainage for Pelvic Abscesses: A Chinese Single-Center Two-year Follow-up Study Highlighting Clinical Outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 06:33:03","doi":"10.21203/rs.3.rs-6586999/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-25T10:39:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-01T12:40:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T10:43:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"11722463014659598336136273947919111996","date":"2025-05-15T11:02:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155361178281903973689988120702435570704","date":"2025-05-14T11:13:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-13T10:43:03+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-13T10:42:07+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-12T07:34:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-09T15:08:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2025-05-09T15:06:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d659cf64-3bdd-4343-9350-bb55e3820b25","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T10:01:47+00:00","versionOfRecord":{"articleIdentity":"rs-6586999","link":"https://doi.org/10.1186/s12876-026-04741-5","journal":{"identity":"bmc-gastroenterology","isVorOnly":false,"title":"BMC Gastroenterology"},"publishedOn":"2026-05-02 15:57:02","publishedOnDateReadable":"May 2nd, 2026"},"versionCreatedAt":"2025-05-19 06:33:03","video":"","vorDoi":"10.1186/s12876-026-04741-5","vorDoiUrl":"https://doi.org/10.1186/s12876-026-04741-5","workflowStages":[]},"version":"v1","identity":"rs-6586999","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6586999","identity":"rs-6586999","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}