Treatment of pancreatic pseudocyst and pancreatic abscess using a therapeutic endoscopic ultrasound device.results in 18 patients

Abstract

The purpose of this study is to evaluate a new technic of cystogastro or duodenostomy for pancreatic pseudo-cyst (PPC) or pancreatic abscesses (PA) entirely guided by endoscopic ultrasound (BUS) and using interventional echoendoscopes. Patients and methods : A cystogastrostomy was performed in 17 patients and a cystoduodenostomy in 1 patient for 7 PPC and II PA. For 16/17 patients, the gastroscopy did not reveal extrinsic compression allowing selection of the puncture site. The origin of the PPC was an alcoholic chronic pancreatitis in 3 cases and an acute pancreatitis due to lithiasis in 2 cases and a hyperlipidemia in 2 cases. The origin of the 11 PA was post-operative acute pancreatitis. The mean size of the 17 pancreatic cysts was respectively 7.5 ern (410 cm).The EUS device was the FG 38X manufactured by Pentax-Hitachi. The FG 38X is an interventional echoendoscope with a working channel of 3.2 mm of diameter .Technique of EUS guided cystogastrostomy : 1/locating the PPC and the contact zone between the gastric wall and the cyst wall. 2/ Color doppler assessment of the stomach wall showed no vascularization in this contact zone 3/ A needle-knife was introduce through the working channel and used to performed EUS guided transgastric puncture of the cyst 4/ The metal part of the needle-knife was withdrawn leaving the teflon catheter in the cyst 5/ A guide wire is introduce through the teflon catheter in the cyst 6/ Under this guide-wire a 6.5 or 7 F naso-cystic drain or a 8.5 F stent was placed within the cyst. Results : No complication occurred. The placement of the nasocystic drain or the 8.5 F stent was successful respectively in 11/12 cases and 5/5 cases. The drain was removed after 5 -10 days and the stent 3 months later. In one case, it was no possible to place the drain and only an aspiration was performed. One recurrence of the 7 pseudo-cyst and 2 relapses of the 11 PA have been observed with a mean follow-up of 24 months (14-32 months).Conclusion : This experience suggest that this technique allows more accurate drainage of the PPC or PA without extrinsic compression with a lower risk of perforation and haemorrhage.