Combined EUS-Guided Abdominal Cavity Drainage and Cystogastrostomy for the Ruptured Pancreatic Pseudocyst

Ge Nan,Sun Siyu,Liu Xiang,Wang Sheng,Wang Guoxin

doi:10.1155/2013/785483

Abstract

Background. Endoscopic-Ultrasonography- (EUS-) guided puncture and drainage of pancreatic pseudocyst is currently one of the most widely accepted nonsurgical treatments. To date, this technique has only been used for pancreatic pseudocysts adhesive to the gastric wall. This study introduces the technique of EUS-guided pseudocyst drainage and additional EUS-guided peritoneal drainage for the ruptured pseudocyst. Methods. Transmural puncture and drainage of the cyst were performed with a 19 G needle, cystotome, and 10 Fr endoprosthesis. Intraperitoneal drainage was performed with a nasobiliary catheter when rupture of pseudocyst occurred. The entire procedure was guided by the echoendoscope. Results. A total of 21 patients, 8 men and 13 women, with a mean age of 36 years, were included in this prospective study. All of the pseudocysts were successfully drained by EUS. Peritoneal drainage was uneventfully performed in 4 patients. There were no severe complications. Complete pseudocyst resolution was established in all patients. Conclusion. The technique of EUS-guided transmural puncture and drainage, when combined with abdominal cavity drainage by a nasobiliary catheter, allows successful endoscopic management of pancreatic pseudocysts without adherence to gastric wall.

Highlights

Endoscopic-Ultrasonography- (EUS-) guided pancreatic pseudocyst puncture and drainage are a widely accepted nonsurgical intervention [1,2,3,4,5].Recent advances in understanding of the pathophysiology of pancreatic pseudocysts (PPs) allow the selection of optimal candidates for minimally invasive treatment approaches [6]
Inclusion criteria for this study are as follows: (1) pancreatic pseudocyst without adherence to gastric wall confirmed by CT and EUS; (Figures 1(a), and 1(b)) (2) pancreatic pseudocyst presenting with severe symptoms, such as abdominal pain, abdominal distension, duodenal obstruction, or biliary obstruction; (3) asymptomatic patient with pancreatic pseudocyst larger than 5 cm
A total of 86 patients with pancreatic pseudocyst treated at Shengjing hospital between May 2005 and June 2011 were enrolled in this study. 21 patients (13 women, 8 men) with pancreatic pseudocyst without adherence to gastric wall were selected for this procedure (Table 1)

Summary

Introduction

Endoscopic-Ultrasonography- (EUS-) guided pancreatic pseudocyst puncture and drainage are a widely accepted nonsurgical intervention [1,2,3,4,5].Recent advances in understanding of the pathophysiology of pancreatic pseudocysts (PPs) allow the selection of optimal candidates for minimally invasive treatment approaches [6]. Endoscopic-Ultrasonography- (EUS-) guided pancreatic pseudocyst puncture and drainage are a widely accepted nonsurgical intervention [1,2,3,4,5]. EUS-guided drainage of cysts without adherence to gastric wall can cause cyst collection leakage or even rupture, and for these patients a transpapillary or other approach is usually chosen [7]. Endoscopic-Ultrasonography- (EUS-) guided puncture and drainage of pancreatic pseudocyst is currently one of the most widely accepted nonsurgical treatments. To date, this technique has only been used for pancreatic pseudocysts adhesive to the gastric wall. The technique of EUS-guided transmural puncture and drainage, when combined with abdominal cavity drainage by a nasobiliary catheter, allows successful endoscopic management of pancreatic pseudocysts without adherence to gastric wall

Methods

Results

Conclusion