Endoscopic ultrasound (EUS)-guided drainage of liver abscesses (EUS-LAD) is gaining increasing importance as an alternative to percutaneous drainage, particularly for left-sided or anatomically challenging abscesses. The aim of this retrospective multicenter analysis was to evaluate EUS-guided drainage of liver abscesses with regard to technical feasibility, clinical success and safety.

Retrospective multicenter analysis of EUS-LAD cases from six centers in the DACH region since 2020. Primary endpoints were technical and clinical success rates as well as the occurrence of adverse events (AEs). Secondary endpoints included the access route, types of stents used, as well as required stent exchanges and duration of drainage.

A total of 17 patients were included. The median age was 64 years (range 45–85 years); 11 patients (64.7%) were male.The technical success rate was 94.1% (16/17 patients). Clinical success with a marked decrease in CRP and a significant reduction in abscess size was observed in 16/16 patients (100%). One mild AE (6.25%) occurred in the form of post-interventional bacterial translocation, which was managed conservatively with antibiotic therapy. All drainages were placed via a transgastric access route. In 2/16 cases, a percutaneous drainage had already been performed prior to EUS-guided drainage placement. In 7/16 cases, a lumen-apposing metal stent (LAMS) was used, in 7/16 plastic stents, and in 2/16 a combination of LAMS and plastic stents.The median duration of drainage was 46 days (IQR 34–68; range 20–137). An endoscopic stent exchange was performed in 4/16 patients. In 5/16 patients with metastatic malignancy, stent removal was not performed due to the palliative situation.

EUS-LAD for left-sided liver abscesses demonstrated a high technical and clinical success rate and proved to be very safe. Thus, EUS-LAD may represent an effective and safe therapeutic option for left-sided liver abscesses and a good alternative to percutaneous drainage.