A case of endoscopic necrosectomy after transgastric EUS-guided drainarge of pancreatic pseudocyst

Abstract

A 49 year-old man with pancreatic pseudocyst after severe acute pancreatitis was hospitalized due to an abdominal pain with the increased pancreatic pseudocyst on October 8, 2004. Abdominal CT on admission showed the giant pancreatic pseudocyst more than 15cm in diameter. EUS-guided fine needle aspiration (FNA) was performed to the pancreatic pseudocyst by transgastric route, using 19G needle (Wilson-Cook) with linear array echoendoscopes. We inserted guide wire (0.035 inch) into the pseudocyst and placed 7Fr pig tail type nasocystic drain into the pseudocyst, and the size of the pseudocyst was slightly reduced. Irrigation of pseudocyst with physiological saline and injection of antibiotics into the pseudocyst were performed, because methicillin resistant staphylococcus aureus and gram negative rod were detected from the culture of the contents. Despite of these treatments, the size of the pseudocyst was not decreased and remittent fever was continued, multiple pigtail stents were placed from the gastric wall into the pseudocyst after balloon dilatation on November 16, 2004, and a few days after the endoprosthesis, endoscopic necrosectomy was done endoscopically using baskets and forceps. After total nine times of endoscopic necrosectomy, the pancreatic pseudocyst (pancreatic abscess) was successfully treated. The patient discharged on December 23, 2004, and no sign of recurrence was observed during 17 months. We experienced a successful case of endoscopic necrosectomy after transgastric EUS-guided drainarge of pancreatic pseudocyst.