To assess the efficacy and safety of transmural (through the rectal wall) drainage of perianal abscesses under the EUS guidance.

Prospective analysis of treatment outcomes for patients with perianal abscesses who underwent EUS-guided transmural drainage between 2019 and 2025 at the Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum Nicolaus Copernicus University in Toruń, Poland. In all patients, during the initial endoscopic procedure, endoluminal puncture of the abscess through the rectal wall was performed under endoscopic ultrasound guidance. Subsequently, a Lumen-Apposing Metal Stent (LAMS) was inserted through the puncture site after dilation, through which a drain was introduced into the abscess cavity for postoperative salvage. Subsequent endoscopic procedures included irrigation of the abscess and ultimately removal of the LAMS when complete collapse of the collection was observed. 

In 6 patients (6 men; mean age 39.57 [28-72] years) with perianal abscesses, transmural endoscopic drainage was performed. In 5/6 (83.33%) patients, perianal abscesses were caused by complicated diverticulitis; in 1/6 (16.67%) patients, the abscess was a consequence of ulcerative colitis. The mean abscess size was 78 (46-132) mm. The mean number of endoscopic procedures (endoscopic revision of abscess cavity with irrigation) was 2.8 (2-6). The mean time of treatment was 6 (4-12) days. Successful endoscopic treatment of perianal abscesses, which was defined as the resolution of clinical symptoms and complete regression of the abscess, was achieved in all 6 patients. No complications related to EUS-guided treatment were observed. The patients were followed subsequently in CT scan during mean period of 981 (224-1516) days, where no abscess recurrence was observed in all patients.

EUS-guided transmural drainage of perianal abscesses seems safe and effective and potentially might be alternative for more invasive treatment.