Abstract
Background. Endoscopic ultrasound- (EUS-) guided drainage is generally performed under fluoroscopic guidance. However, improvements in endoscopic and EUS techniques and experience have led to questions regarding the usefulness of fluoroscopy. This study aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage of extraluminal complicated cysts without fluoroscopic guidance. Methods. Patients who had undergone nonfluoroscopic EUS-guided drainage of extraluminal complicated cysts were enrolled. Drainage was performed via a transgastric, transduodenal, or transrectal approach. Single or double 7 Fr double pigtail stents were inserted. Results. Seventeen procedures were performed in 15 patients in peripancreatic fluid collections (n = 13) and pelvic abscesses (n = 4). The median lesion size was 7.1 cm (range: 2.8–13.0 cm), and the mean time spent per procedure was 26.2 ± 9.8 minutes (range: 16–50 minutes). Endoscopic drainage was successful in 16 of 17 (94.1%) procedures. There were no complications. All patients experienced symptomatic improvement and revealed partial to complete resolution according to follow-up computed tomography findings. Two patients developed recurrent cysts that were drained during repeat procedures, with eventual complete resolution. Conclusion. EUS-guided drainage without fluoroscopic guidance is a technically feasible, safe, and effective procedure for the treatment of extraluminal complicated cysts.
Highlights
The options for drainage of extraluminal complicated cysts, including peripancreatic fluid collections (PFCs), walled-off pancreatic necrosis (WOPN), and other abdominal and pelvic abscesses, have involved percutaneous or surgical approaches
Many studies have investigated Endoscopic ultrasound- (EUS-)guided therapy of extraluminal complicated cysts, especially pseudocysts and WOPN, and this minimally invasive technique is regarded as a feasible option for definitive endoscopic treatment [6]
Only a few reports have described EUSbased approaches to the drainage of other abdominopelvic abscesses, the procedure has been described as safe and effective in abscesses not amenable to drainage via various routes under ultrasound (US) or computed tomography (CT) guidance [7]
Summary
The options for drainage of extraluminal complicated cysts, including peripancreatic fluid collections (PFCs), walled-off pancreatic necrosis (WOPN), and other abdominal and pelvic abscesses, have involved percutaneous or surgical approaches. Since the introduction of endoscopic ultrasound (EUS) in the 1990s, abdominal organs in the nearby gastrointestinal tract have been accessed for drainage This procedure enables access to nonbulging lesions or abscesses without luminal compression and can be performed in patients with venous collaterals and those with a small anatomic window for drainage [4, 5]. Many studies have investigated EUS-guided therapy of extraluminal complicated cysts, especially pseudocysts and WOPN, and this minimally invasive technique is regarded as a feasible option for definitive endoscopic treatment [6]. Endoscopic ultrasound- (EUS-) guided drainage is generally performed under fluoroscopic guidance. This study aimed to retrospectively evaluate the safety and efficacy of EUS-guided drainage of extraluminal complicated cysts without fluoroscopic guidance. EUS-guided drainage without fluoroscopic guidance is a technically feasible, safe, and effective procedure for the treatment of extraluminal complicated cysts
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