P1460 - EUS-Guided Drainage With LAMS in Pediatric Perirectal Abscesses: Indications, Outcomes, and Safety

Aarushi Sudan, MD¹, Elias Estifan, MD², Darshana Prem Anand, MD¹, Ahan Bhatt, MD³, Sammy Ho, MD², Inna Novak, MD^4
1NYC Health + Hospitals/Jacobi, New York, NY; ²Montefiore Medical Center, New York, NY; ³Albert Einstein College of Medicine, New York, NY; ⁴Hackensack University Medical Center, Hackensack, NJ

Introduction: Previously necessitating surgical intervention, fluid collections around the rectum can now be effectively drained through minimally invasive methods. The success of Endoscopic Ultrasound (EUS)-guided drainage for abdominal fluid collections in adults has prompted exploration of its application in the pediatric population. EUS guided drainage with Lumen Apposing Metal Stent (LAMS) placement has mainly been studied for pancreaticobiliary etiologies in children. However, the utilization of LAMS for pediatric perirectal abscesses remains an area where its role is yet to be established. In this study, we aim to assess the indications, outcomes, and complications associated with EUS-guided drainage utilizing LAMS placement in pediatric patients at our institution.

Methods: A retrospective chart review was conducted on pediatric patients who underwent EUS-guided drainage of perirectal fluid collections using LAMS at Montefiore between 2015 and 2023. We identified six patients aged 9 to 18 years. The main outcome measures included technical and clinical success and associated adverse events with LAMS placement. Technical success (TS) was defined as ≥50% drainage of the fluid collection without adverse events, while clinical success (CS) encompassed symptom resolution, ≥50% reduction in inflammatory parameters, and absence of recurrences.

Results: Six patients with perirectal abscesses were identified. Among these, three abscesses resulted from a perforated viscus, while three were post-surgical. The average indwelling time for the perirectal abscess stent was 12 days. Follow-up imaging performed after a median of 7 days revealed complete resolution of abscesses in all patients. Stents were then endoscopically removed using a snare. Technical and clinical success rates were both 100%. No recurrences were observed during a median 12-month follow-up.

Discussion: Pediatric EUS is a rapidly evolving field, paralleling its advancements in adult patients. Similar to adults, the application of LAMS can achieve outstanding results in treating perirectal abscesses in the pediatric population. EUS-guided drainage offers significant advantages, including the avoidance of ionizing radiation, prompt pain relief, and a reduction in adverse events compared to conventional surgical and percutaneous alternatives. Despite the limitation in the number of patients included in our study, our findings underscore the efficacy and safety of utilizing LAMS for draining perirectal abscesses in pediatric patients.


Disclosures:


Aarushi Sudan, MD¹, Elias Estifan, MD², Darshana Prem Anand, MD¹, Ahan Bhatt, MD³, Sammy Ho, MD², Inna Novak, MD⁴. P1460 - EUS-Guided Drainage With LAMS in Pediatric Perirectal Abscesses: Indications, Outcomes, and Safety, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.