Novel less-invasive therapy for liver abscess: combining lavage and draining through a single device.

Background and Aims: The management of liver abscess is based on percutaneous drainage and antibiotics, whereas surgery is reserved for complex or refractory cases. Endoscopic therapy is restricted to abscesses with biliary duct communication. We describe a promising technique for managing liver abscesses after conventional treatment failure. Methods: We present the first case report of a minimally invasive therapy for managing liver abscess in a high-risk patient after GI surgery. In this case, an ultraslim endoscope was inserted inside the collection to allow direct necrosectomy, followed by endoscopic vacuum therapy (EVT) using a double-lumen tube for lavage and drainage through a single device. Results: A 55-year-old woman who underwent robot-assisted gastrectomy for gastric adenocarcinoma was readmitted on the seventh postoperative day with a liver abscess and extensive liver necrosis. Image-guided percutaneous drainage was performed without clinical improvement. Endoscopic management was chosen as rescue therapy. Extensive lavage with saline solution was performed, and a homemade modified EVT with an instillation device was placed. After 14 days, there was resolution of the collection, and the patient did not present recurrence within 6 months of follow-up. Conclusions: This novel homemade EVT combining drainage and lavage is feasible and appears to be safe and effective for managing liver abscess, especially when conventional therapies fail. This approach allows bedside evaluation inside the collection and accurate control of responsiveness to treatment. Furthermore, it enables therapeutic procedures such as direct necrosectomy and insertion of an EVT tube. Further studies are necessary to confirm this hypothesis.