EUS ‐Guided Versus Percutaneous Transhepatic Drainage of Liver Abscesses: A Multicenter Endohepatology Study in Western Japan ( EPIC ‐ LA Study)

Objective Percutaneous transhepatic liver abscess drainage (PTAD) and endoscopic ultrasound‐guided liver abscess drainage (EUS‐LAD) have several limitations. Recently, because of technical improvements in echoendoscope maneuvers, EUS‐guided access for the right hepatic lobe has been reported. The aim of this multicenter, retrospective study was to compare clinical outcomes of PTAD and EUS‐LAD including the right hepatic lobe in West Japan. Method This retrospective, multicenter study included consecutive patients with liver abscesses between January 2019 and November 2024. The primary outcome in this study was the clinical success rate compared between EUS‐LAD and PTAD. Results During the study period, 1012 consecutive patients developed liver abscesses. Of them, 734 patients were excluded, 43 underwent EUS‐LAD and 235 patients underwent PTAD. After propensity score‐matched analysis, the clinical success rate was significantly higher in the EUS‐LAD group (97.7%, 42/43) than in the PTAD group (79.1%, 34/43) ( p = 0.007). After a propensity score‐matched analysis, 25 patients were included in each group. The clinical success rate was significantly higher in the EUS‐LAD group (100%, 25/25) than in the PTAD group (84%, 21/25) ( p = 0.037). Adverse events were also significantly higher in the PTAD group (16%, 5/25) than in the EUS‐LAD group ( p = 0.025). In addition, the median length of hospital stay was significantly shorter in the EUS‐LAD group (15 days) than in the PTAD group (22 days) ( p = 0.005). Conclusions EUS‐LAD using a metal stent might be one of the options, but further randomized, controlled trials are needed.