3502 A new device for endoscopic, transmural, drainage of symptomatic pancreatic pseudocysts.

Abstract

Endoscopic transmural drainage of a pancreatic pseudocyst is a technically demanding procedure. An instrument that allows easy cyst puncture and catheter drainage is much needed. Methods: to design a drainage device that allows endoscopic pseudocyst puncture and passage of a large bore drain in a single step. This device must have the following functions: 1) allow rapid insertion of a 10 French double pigtail stent; 2) retrieve or adjust the stent during a deployment attempt without losing pseuodcyst access or having to remove the endoscope; 3) confirm pseudocyst access by contrast injection; 4) re-loadable for placement of additional drains. We have designed a device that has a central diathermy needle at its tip, a stent pusher, and a double pig-tail stent that is held in place by a cable. Results: Five of 6 patients have been successfully treated with this device. However, several technical problems were encountered initially. In the first patient, the cable broke before stent deployment. In the second and third patients, an assistant had to manually hold on to the cable to secure the stent. The cable had to be cut for stent release, and stent re-loading was time consuming. Endoscopic pseudocyst puncture failed in the fourth patient, due to difficulty in establishing access. Additonally, cable breakage necessitated endoscope removal from this patient. After multiple device modifications that included using a stronger cable and a self-locking mechanism, the last 2 patient had four stent placements without any difficulty. The time needed for cyst puncture, contrast injection, and stent insertion and release range from 1-5 minutes. Stent re-loading was accomplished rapidly. In total, 7 drains have been successfully placed with this device without any complications directly related to it. Conclusions: a new, singlestep endoscopic pseudocyst drainage device has been created, negating time-consuming, complicated procedures that may involve guidewire exchange and transmural dilation. Loss of endoscopic visualization and pseudocyst access may be prevented with the use of this device. A larger clincal experience is needed to confirm its values.