LAUSR

Gastric wall abscess (GWA) is a rare adverse event of EUS-FNA. There have been a few reports of therapeutic interventions for GWA, such as EUS-guided drainage or surgical drainage. We report a case of GWA that was successfully treated by the endoscopic unroofing technique (Video 1, available online at www.VideoGIE.org). A 68-year-old woman was referred for evaluation of a pancreatic tail mass (maximum diameter, 3.2 cm). To obtain specimens for histologic examination, transgastric EUS-FNA was performed with a 22-gauge needle (3 passes). The mass was diagnosed as adenocarcinoma, and the patient underwent adjuvant chemotherapy before curative resection. One month after EUS-FNA, the patient was hospitalized with high-grade fever and upperabdominal pain. Abdominal CT showed a rim-enhancing irregular cystic mass (maximum diameter, 4.4 cm) extending from the pancreatic tail to the posterior gastric wall (Fig. 1). The laboratory findings were as follows: white blood cell count, 9200/mm (percentage of neutrophils, 86.3%); serum C-reactive protein level, 21.54 mg/dL, hemoglobin A1c, 9.1%. Pyogenic GWA was suspected. Intravenous antibiotic therapy (meropenem 1 g every 12 hours) was started as soon as the patient was admitted. EGD (GIF Type H260; Olympus Medical System, Tokyo, Japan) on day 3 showed a bulging mass with purulent fluid appearing from the mucosa in the posterior gastric wall (Fig. 2). EUS (GF Type UCT-260; Olympus Medical) showed a submucosal mass arising mainly from the second