|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 6 | Page : 418-419
Large liver abscess after endoscopic ultrasound-guided fiducial placement
Galab M Hassan, Sarto C Paquin, Anand V Sahai
Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Québec, Canada
|Date of Submission||22-Mar-2016|
|Date of Acceptance||09-Feb-2017|
|Date of Web Publication||15-Dec-2017|
Dr. Galab M Hassan
Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal, Hopital Saint-Luc, Porte 8400, 1058 St Denis, Montreal, Qc H2X 3J4
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Hassan GM, Paquin SC, Sahai AV. Large liver abscess after endoscopic ultrasound-guided fiducial placement. Endosc Ultrasound 2017;6:418-9
Endoscopic ultrasound-guided fiducial placement (EUS-FP), performed to facilitate stereotactic body radiation therapy, is feasible and safe., Antibioprophylaxis is not recommended currently by existing guidelines. We report the first case of a large liver abscess and sepsis after EUS-FP.
A 67-year-old female with colon cancer and a single, metastatic, 3 cm left lobar liver lesion was referred for EUS-FP. A single fiducial was back-loaded into the 19-gauge needle (Cook, EchoTip ®); the tip was then sealed with sterile bone wax [Figure 1] and [Figure 2]. After placement of the first fiducial, the needle was then withdrawn from the scope to back-load the next fiducial. Three fiducials were placed in total using this method. No prophylactic antibiotics were administered.
|Figure 1: Under sterile conditions, the fiducial is back-loaded into the needle tip|
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Six weeks postprocedure, the patient was admitted to the intensive care unit with abdominal pain and septic shock. Computed tomography scan revealed a 10 cm intrahepatic/perigastric abscess in the region where the fiducials had been placed. All resolved with antibiotics and percutaneous drainage. Our institution has performed 43 EUS-FP to date, with only one reported infectious complication (Case #38). We now administer antibioprophylaxis to all patients undergoing EUS-FP.
The role of prophylactic antibiotics for EUS-FP was unclear. To the best of our knowledge, only two infectious complications have been reported previously; one cholangitis after EUS-FP of porta hepatis nodes and  one cholangitis after EUS-FP for pancreatic head cancer. In both cases, it was uncertain if the infection was related to the procedure or to malignant biliary obstruction. Recent studies with EUS-FP did not systematically administer antibioprophylaxis.,
In conclusion, postprocedural liver abscess is a possible complication of EUS-FP. Excessive manipulation of the needle, related to the “semi-sterile” back-loading technique, is probably responsible for our reported complication. Therefore, we believe that antibioprophylaxis pre- and post-EUS-FP in these conditions is a reasonable recommendation, and guidelines for prophylaxis should be amended appropriately. EUS-FP infectious risk could likely also be reduced using a needle that allows placement of multiple fiducials, without manual back-loading.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]