Utilization of EUS for Endoscopic Drainage of Pancreatic Pseudocysts: Results of a National and an International Survey

Abstract

Utilization of EUS for Endoscopic Drainage of Pancreatic Pseudocysts: Results of a National and an International Survey Tony E. Yusuf, Todd H. Baron Introduction: Pancreatic pseudocysts are a type of pancreatic fluid collection that can complicate acute and chronic pancreatitis. Pancreatic pseudocysts can be drained endoscopically via the transpapillary or the transmural (transgastric or transduodenal) routes. Aim: The aim of this study was to assess the endoscopic approach and techniques of pancreatic pseudocyst drainage as performed by endoscopists in the United States and internationally. Methods: A web-based survey was designed to assess the type of practice and the endoscopic techniques used in drainage of pancreatic pseudocysts. Questions that addressed imaging modalities used prior to or during drainage were included. An initial electronic message with a link to the web survey followed by a reminder message was sent to endoscopists in the United States and internationally. E-mail addressees were obtained from the ASGE membership directory. Results: The survey was sent to 3,054 endoscopists of whom 266 (8.7%) replied. Of the responders, 198 performed endoscopic drainage of pancreatic pseudocysts. Each endoscopist performed a mean of 69 cases (range, 1-364 cases). The transgastric route was the most commonly used drainage route (98%) versus transduodenal (72%). Transmural entry was performed using a needle knife in 53% of the non EUS-guided transmural drainage. The number of stents placed was 1-4 stents for a period of 2-24 weeks. Imaging studies to guide drainage included CT scan alone (60%) or in combination with other radiographic imaging (35%). EUS imaging was used prior to drainage by 72 of 103 (70%) endoscopists in the US compared to 56 of 95 (59%) international endoscopists (pZ0.1). EUSguided drainage was used by 56% of endoscopists in the US compared to 43% international endoscopists (pZ0.06). Conclusions: The transgastric route is the most common route for transmural endoscopic drainage of pancreatic pseudocysts. Computed tomography is the most commonly used pre-drainage imaging modality. The majority of endoscopists in both the US and abroad utilize EUS prior to and during transmural drainage of pancreatic pseudocysts. The practice of EUS prior to drainage is not significantly different among endoscopist in the United States and internationally. T1226 Role of ERCP in Patients with Pancreatico-Biliary (PB) Disease in the Setting of Hematopoietic Stem Cell Transplant (HSCT) Majed Al Nusair, Margarida C. de Magalhaes-Silverman, William B. Silverman Background: Patients (pts) undergoing HSCT may develop PB complications that may need to be evaluated by ERCP. These pts are immunocompromised and may be at higher risk of procedure related complication than average risk pts. Surprisingly, few data have been published regarding ERCP findings/benefits/risks in this population. Aim: To determine the role of ERCP in the diagnosis, treatment, and outcome ERCP in the setting of HSCT. Materials M 15/ 16 had allogeneic HSCT & 1/16 had autologous HSCT. Indications for HSCTwere: AML (6),CML (3), ALL (1), NHL (2), myeloma (1), met breast ca (2). 26 ERCP procedures were performed in these 16 pts. 10/16 pts were O100days post HSCT. 8/26 had a platelet count! 50x103/L. ERCP indications: obstructive jaundice (4); possible ascending cholangitis (7); post cholecystectomy bile leak (1); relapsing pancreatitis (4).ERCP Findings were: BD lithiasis (7), Ampullary infiltration from GVHD (3), BD stricture(1), BD leak (1),cholangitis (1), Mirrizzi (1), PD stone (1), normal (1). ERCP interventions were: BD sphincterotomy (8), BD lithiasis removal (11), BD stents (13), NB tube(4), PD stent for drainage(1), prophylactic temporary PD mini stents (6), Transpapillary endoscopic GB drain (2). Complications occurred in 3 pts: bleed (1), cholangitis due to late stent occlusion (1), mild pancreatits (1). No deaths. Conclusion: In patients with HSCT, BD lithiasis was the most common finding at ERCP, followed by obstructive ampullary tissue infiltration due to GVHD. ERCP was safe and successful in this population.