Endosonography-guided pseudocyst drainage

Abstract

The application of endosonography ultrasound (EUS) to guide the puncture of a pseudocyst through the wall of the stomach or duodenum represents a technological breakthrough. Endoscopyguided drainage has been limited by its relatively “blind” approach, suited only for pseudocysts that produce prominent bulging into the bowel lumen. EUS provides a highly detailed view of the topographical interface between the pseudocyst and the bowel wall; the distance between the pseudocyst and the bowel wall can be measured to the millimeter, and subsurface vessels are readily detected. Although the technique of EUS-guided pseudocyst drainage is well established, widespread dissemination of this approach must await the development of echoendoscopes with larger working channels, dedicated pseudocyst puncture needles, and dedicated pseudocyst drainage stents. Further studies are needed to determine the optimal size and number of stents to achieve stent drainage and the optimal duration of cyst drainage.