Endoscopic Drainage Of Pancreatic Pseudocysts Research Articles

Endoscopic Drainage of Pancreatic Pseudocysts: Clinical Profile and Outcome Analysis.

Pancreatic pseudocyst is a complication of acute and chronic pancreatitis. Although surgery considered the gold standard, there is a rapid shift towards endoscopic treatment owing to its therapeutic outcome and minimal invasive involvement. This study aims to present the clinical profile and outcome analysis of the endoscopic drainage of pancreatic pseudocysts in Dhulikhel Hospital. This is a retrospective review of all patients who were diagnosed with pancreatic pseudocyst between January 2015 and December 2018 in Dhulikhel Hospital. The retrospective data were on patient characteristics, etiology, location of the cyst, other clinical characteristics. The study included 51 patients and the average age of the patients in this study was 39 years and among them 62.7% were female. The mean size of pseudocyst was 7.89 cm, and the average days of hospital stay was 13.64. The most common etiology was idiopathic and more than half of the patient's cyst was in head and/or body, 15 and 36 underwent conservative and therapeutic management respectively. The technical success rate was at 94% and reported increased pancreatic pseudocyst in Dhulikhel Hospital from 2015-18. The study findings highlight the increased trend of pancreatitis pseudocyst as a complication of acute or chronic pancreatitis. Endoscopic drainage of pseudocyst with plastic stent is an established method of managing it. However, pancreatic pseudocyst even larger than 6 cm can undergo spontaneous resolution.Hence, conservative management should be considered first.

A Retrospective Study on Comparison Between Surgical and Endoscopic Management of Pancreatic Pseudocyst and Walled-off Pancreatic Necrosis

BACKGROUND: Surgical management is the standard approach for pancreatic pseudocyst and walled off pancreatic necrosis. With newly evolving procedures and a comprehensive approach, management of walled off pancreatic necrosis and pancreatic pseudocyst is taking a new turn. A multi-centric study comparing surgical and endoscopic management of pancreatic pseudocyst and walled off pancreatic necrosis was performed. METHODS: Data was collected retrospectively from multiple centers and patients were followed up till date since the time of intervention. The outcomes were therapeutic success, post-operative complications, recurrence rate, mortality and duration of hospitalization. RESULTS: At the end of the follow-up period, none of the patients who received endoscopic intervention had a recurrence, compared to 2 patients in the surgical group. There was 16.67% mortality in the surgical group and only 3.33% mortality in the endoscopic group. Significantly high mortality was seen in the patients with Walled-Off Pancreatic Necrosis treated surgically, compared to no mortality in the patients treated endoscopically. 86 % of the patients in the endoscopic group had resolution of the disease following intervention compared to 70% in the other group. There were no statistically significant differences in mortality, resolution or recurrence of disease following intervention between the two groups. However, the length of hospital stay was significantly shorter for patients who underwent endoscopic intervention than open surgery. CONCLUSION: Endoscopic drainage of Pancreatic Pseudocysts and Walled off Pancreatic necrosis have demonstrated a therapeutic success rate, mortality and recurrence statistically comparable to that seen in surgical treatment, but with reduced time of hospitalization, supporting its use as the preferred initial modality for drainage.

S161 Outcomes of Endoscopic Drainage of Pancreatic Pseudocysts in Patients With COVID-19: Sepsis Is a Poor Prognostic Marker

S161 Outcomes of Endoscopic Drainage of Pancreatic Pseudocysts in Patients With COVID-19: Sepsis Is a Poor Prognostic Marker

Experience of transmural endoscopic drainage in treatment of pancreatic pseudocysts

Objective. To evaluate the possibilities of transmural endoscopic drainage in the treatment of postnecrotic pancreatic pseudocysts in the immediate and long-term periods. Materials and methods. From 2018 to 2022, a transmural endoscopic drainage method was used in the treatment of 36 patients with pancreatic pseudocysts at Perm Regional Clinical Hospital. The results were evaluated in the immediate postoperative period, 47 months before the removal of the stent and 14 years by the complaints of patients, blood amylase content, the results of ultrasound and CT examination of the abdominal cavity. Results. Two-three days after the endoscopic intervention, the cyst completely disappeared in 30.56 % of patients, decreased by half or more of the diameter in 63.89 % and only in 5.56 % decreased slightly. After 14 years, the absence of cysts was registered in 80 %, small diameter (from 15 to 24 mm) in 10 %. Pancreatic cysts persisted in three patients (10 %). Statistical analysis showed that the wider was the main pancreatic duct and the higher the blood amylase level before transmural endoscopic drainage, the poorer was the treatment result. Conclusions. Transmural endoscopic drainage of pancreatic pseudocysts makes it possible to achieve complete disappearance or significant reduction in the size of pancreatic cysts a year or more after the intervention in 90 % of cases. The clinical result of transmural endoscopic drainage in the treatment of pancreatic pseudocysts depended on the initial width of the main pancreatic duct and the level of blood amylase.

Splenic injury following endoscopic drainage of a large pancreatic pseudocyst: a case report

BackgroundMany pancreatic pseudocysts spontaneously resolve, but larger or symptomatic pseudocysts may require procedural management. Though endoscopic ultrasound guided approaches are standard of care and have high success rates, complications can include bleeding, infection, and splenic perforation. This patient case report details an unusual series of complications of endoscopic cystogastrostomy that should encourage clinicians to evaluate for anatomic disruptions caused by mass effects of pancreatic pseudocysts prior to endoscopic pseudocyst drainage.Case presentationA 53-year-old African American male with a past medical history notable for alcohol use disorder, chronic pancreatitis, and insulin dependent diabetes presented with a 4-day history of left upper quadrant abdominal pain. Computed tomography imaging with contrast revealed enlargement of a known pancreatic pseudocyst to 15.9 × 10.4 cm. Due to pseudocyst size and the patient’s symptoms, endoscopic cystogastrostomy stent placement was performed. However, postprocedurally, he developed leukocytosis to 19,800 cells/m3 (from 14,100 cells/m3 preoperatively) as well as acute hypoxemic respiratory failure with a large left pleural effusion. Postprocedural computed tomography with contrast demonstrated a new large subcapsular splenic hematoma in communication with a new subdiaphragmatic fluid collection. Due to suspicion of endoscopic procedural complication, he underwent open laparotomy which revealed grade 4 splenic laceration, septic splenic hematoma, and a subdiaphragmatic abscess.ConclusionsWhile endoscopic drainage of pancreatic pseudocyst was technically successful, this case demonstrates complications from mass effect of a large pancreatic pseudocyst which putatively tore the splenorenal ligament, leading to excessive separation of the left kidney and spleen. If anatomic disruptions caused by mass effect from a pancreatic pseudocyst are recognized through preprocedural abdominal imaging, such cases may be considered for early open repair versus cystogastrostomy.

Endoscopic versus surgical treatment for pancreatic pseudocysts

Objective:This systematic review and meta-analysis aims to compare surgical and endoscopic treatment for pancreatic pseudocyst (PP).Methods:The researchers did a search in Medline, EMBASE, Scielo/Lilacs, and Cochrane electronic databases for studies comparing surgical and endoscopic drainage of PP s in adult patients. Then, the extracted data were used to perform a meta-analysis. The outcomes were therapeutic success, drainage-related adverse events, general adverse events, recurrence rate, cost, and time of hospitalization.Results:There was no significant difference between treatment success rate (risk difference [RD] −0.09; 95% confidence interval [CI] [0.20,0.01]; P = .07), drainage-related adverse events (RD −0.02; 95% CI [−0.04,0.08]; P = .48), general adverse events (RD −0.05; 95% CI [−0.12, 0.02]; P = .13) and recurrence (RD: 0.02; 95% CI [−0.04,0.07]; P = .58) between surgical and endoscopic treatment.Regarding time of hospitalization, the endoscopic group had better results (RD: −4.23; 95% CI [−5.18, −3.29]; P < .00001). When it comes to treatment cost, the endoscopic arm also had better outcomes (RD: −4.68; 95% CI [−5.43,−3.94]; P < .00001).Conclusion:There is no significant difference between surgical and endoscopic treatment success rates, adverse events and recurrence for PP. However, time of hospitalization and treatment costs were lower in the endoscopic group.

Endoscopic drainage of pancreatic pseudocysts under ultrasound guidance in children

Endoscopic drainage of pancreatic pseudocysts under ultrasound guidance in children

Safety and efficacy of lumen-apposing metal stents with and without simultaneous double-pigtail plastic stents for draining pancreatic pseudocyst

Lumen-apposing metal stents (LAMSs) are used to perform necrosectomy in walled-off necrosis (WON). Although necrosectomy is not required for pancreatic pseudocyst (PP), an increasing number of PPs are also being drained with LAMSs in view of their ease of deployment. The aim of the present study was to evaluate the safety and efficacy of using LAMSs to drain PPs. At 1 tertiary center from January 2014 to May 2016, all consecutive patients with PPs were drained by LAMSs, and the data were retrospectively reviewed. After observing cyst-cavity infection in patients enrolled initially (group I), 10F double-pigtail stents (DPSs) were placed across LAMSs in the subsequent patients (group II). Data on technical success, PP resolution, adverse events, and reintervention rates were collected. Forty-seven patients with PPs (mean size, 9.5 ± 4.0 cm) were enrolled (group I, 24; group II, 23). There was 1 perforation at deployment (technical success, 98%). In the remaining 46 patients, resolution of the PP was observed in 44 patients (96%). Four patients (17%) in group I presented with PP infection requiring reinterventions. Food material was observed in the cyst cavity. None of the patients in group II had PP infection (relative risk, .84; 95% confidence interval, .71-1.0; P= .054). Similar to WON, LAMSs are also effective in endoscopic drainage of PPs. However, there was a trend toward higher PP infection with LAMSs, and placing a DPS across the LAMS minimized this risk.

Long-term results after endoscopic drainage of pancreatic pseudocysts: A single-center experience

BackgroundPancreatic pseudocysts (PPC) are collections of fluid encapsulated within a well-defined inflammatory wall that develop during pancreatic inflammation. Internal drainage represents the standard of care in lesions that persist and lead to symptoms and complications. Only limited data are available on long-term results and recurrence of PPC after drainage procedures. Thus, the aim of the present study was to analyse the long-term outcome after endoscopic drainage of PPC. Material and methodsPatient data were retrospectively collected by review of clinical records of the University Medical Center Mannheim. We assessed the clinical short-term outcome (results in the first 30 days after initial drainage procedure), medium-term outcome (results 6 months after initial drainage procedure) and long-term outcome (results after stent removal). We performed statistical analysis to identify possible risk factors for recurrence of PPC. ResultsWe identified 51 patients with initially successful endoscopic drainage of the PPC (n = 51/53, 96%). Among this cohort, 43 patients were available for assessment of medium-term results. In 82.9% of these 43 patients the drainage could be removed after successful treatment of the PPC. Thirty patients were available for long term follow-up with a mean observation period of 42.2 months (SD 32.8 months). Among these patients, seven (n = 7/30, 23.3%) had recurrent PPC. Approximately half of the recurrent cysts arose in different anatomical regions and most patients with recurrence had chronic pancreatitis. ConclusionEndoscopic drainage represents an effective treatment for PPC. Approximately one quarter of the patients developed recurrent PPC. Half of recurrent PPC developed in different pancreatic regions than the initial PPC.

Endoscopic Drainage of Pancreatic Pseudocysts: An Experience with 77 Patients

ABSTRACT Background: We evaluated short‑ and long‑term results of endoscopic drainage (a minimally invasive nonsurgical treatment) of pancreatic pseudocysts (PPCs) and factors associated with its success at a multilevel teaching hospital in Northern India, as such data are scanty from India. Patients and Methods: Retrospective review of records of consecutive patients undergoing endoscopic drainage of PPC from January 2002 to June 2013 was undertaken. Results: Seventy‑seven patients (56 males), median age 36 years (range, 15–73), underwent endoscopic drainage of PPC with 98% technical success. Pseudocysts drained were symptomatic (duration 11 weeks, range, 8–68), large (volume 582 mL [range, 80–2706]), located in head (n = 32, 46%), body and tail (n = 37, 54%), and infected (n = 39, 49%). Drainage procedures included cystogastrostomy (n = 54, 78%), cystoduodenostomy (n = 9, 13%), transpapillary drainage (n = 2, 3%), and multiple route (n = 4, 6%), with additional endoscopic nasocystic drainage (ENCD) in 41 (59%). Sixty‑nine patients were followed up (median 28 months, range 2–156; other eight lost to follow‑up). Complications (n = 21, 30%) included stent occlusion and migration (13), bleeding (5), perforation (2), and death (1). Endoscopic procedure had to be repeated in 19 patients (28%; 16 for sepsis, 3 for recurrence). The reasons for additional nonendoscopic treatment (n = 8, 12%) included incomplete cyst resolution (3), recurrence (2), bleeding (1), and perforation (2). Overall success rate of endoscopic drainage was 88%. Whereas infected pseudocysts were associated with poorer outcome (odds ratio [OR] 0.016; 95% confidence interval [CI] 0.001–0.037), placement of ENCD led to better results (OR 11.85; 95% CI 1.03–135.95). Conclusion: Endoscopic drainage is safe and effective for PPC.

Modern Approaches to the Treatment of Chronic Pancreatitis Complicated by Pancreatic Pseudocysts

Aim. Retrospective analysis of conventional and endoscopic surgical treatment of patients with chronic pancreatitis complicated by pancreatic pseudocysts. Material and Methods. For the period from 2011 to May 2017 two hundred and eighty-two patients were treated for chronic pancreatitis. In 91 (32.3%) patients disease was complicated by post-necrotic pancreatic cysts. 38 patients underwent conventional or laparoscopic surgical treatment. Minimally invasive surgical treatment including endosonography-assisted cystogastro-/ cystoduodenostomy was offered to 38 patients. 15 patients with symptomless pancreatic pseudocysts ≤ 5 cm are under follow-up. Results. Mean hospital-stay was 11.2 and 6.4 days after cystojejunostomy and endoscopic drainage respectively. Postoperative morbidity was 10.5% (n = 4) per each group. There were more severe complications after conventional procedures: Clavien–Dindo grade II in 1 patient, grade IIIb in 3 patients. At the same time endoscopic surgeries were followed by complications grade II in 3 patients and grade IIIb in 1 patient. Mean life quality score was 70.2 and 74.3 after traditional and endoscopic interventions respectively. Postoperative follow-up was 3 years for all patients. Conclusion. Internal endosonography-assisted endoscopic drainage of pancreatic pseudocysts may be preferable in patients with chronic pancreatitis.

PWE-157 EUS Guided Trans-Gastric Pancreatic Pseudocyst Drainage- Does Standard Use of Fluoroscopy Just Complicate Things?: Abstract PWE-157 Table 1

Introduction Endoscopic pancreatic pseudocyst drainage is effective and associated with lower morbidity and mortality compared to surgical or percutaneous methods. EUS guidance is now the gold standard intervention due to a higher success rate and lower complication rate compared to blind puncture with fluoroscopic assistance. Many centres still use fluoroscopic guidance with EUS for all cyst-gastroscopy procedures. We present single centre experience of EUS guided pseudocyst drainage and complication rates comparing complication rates with and without fluoroscopic assistance. Methods All EUS guided trans-gastric and trans-duodenal pseudocyst and acute pancreatic fluid collections drainage procedures from 2010 to January 2016 were included. Demographics, use of fluoroscopy and initial success of drainage with stent placement were recorded. All procedures were performed with midazolam and fentanyl sedation without endotracheal tube insertion. Standard trans-gastric drainage was attempted if there was good luminal/gastric wall apposition (cyst distance Results 71 procedures were performed in 68 patients (mean age 50.8, SD 16.1). Immediate drainage was achieved in 69/71 (97.1%) of cases (2 procedures were abandoned due to bleeding). 2 procedures used fully covered metal stents, the remainder used two plastic stents. 2 procedures were performed via the duodenum due to cyst position. 9 patients experienced complications. Although the complications in the fluoroscopy group were more frequent there was no significant statistical difference in complication rates on comparing the two groups (p = 0.25). Conclusion Although fluoroscopy could be helpful in certain circumstances, the routine additional use of fluoroscopy does not reduce complications for EUS guided trans-gastric drainage of pancreatic pseudocysts. Disclosure of Interest None Declared

Endoscopic Ultrasound-Guided Pancreatic Pseudocyst Drainage in Children

Background: Endoscopic drainage of pancreatic pseudocysts is well established in adults and known to be associated with complications including perforation and hemorrhage. One reason for this is that endoscopic drainage is a blind procedure and to overcome this, EUS guided drainage was established. However, there are limited data regarding this procedure in the pediatric age group. The reasons for this are the limited number of cases seen in children and the lack of experienced pediatric gastroenterologist with this technique. Add to this another technical limitation with EUS is that the therapeutic echo endoscope is 14.6 mm in diameter and has a rigid tip that restricts its use in young children. Patients, methods and results: This report describes a 4-year old child weighing 14 kg with a large pancreatic pseudocyst (8x8x12cm) that was treated successfully using adult endoscopic ultrasound scope (The Olympus EVIS LUCERA Ultrasound Gastrovideoscope GF-UCT 260, 14.6 mm distal tip). Conclusion: Endoscopic drainage of symptomatic pancreatic pseudocysts can be achieved safely and effectively in children using the adult EUS scope.

Endoscopic Management of Pancreatic Pseudo cyst Complicated with Obstructive Jaundice: Case Report and Literature Review

Obstructive jaundice due to pancreatic pseudocyst is not common. Local Complications of Pancreatic pseudocyst can be managed with Endoscopic drainage, achieved through transmural approach via stomach or duodenal wall into the cyst, or transpapillary/transductal stent placement. Endoscopic drainage of pancreatic pseudocyst is becoming more favorable nowadays because of shorter hospital stay, lower cost, and lower mortality rate. EUSguided drainage is preferred over conventional endoscopic drainage because of higher technical success rate and because of higher success rate, technical feasibility and quick resolution of pancreatic pseudocyst, fully covered fully covered self-expandable metal stents are recently gaining popularity.

Transient gastric ischemia as a complication of cystotomy in endoscopic pancreatic pseudocyst drainage

A 70-year-old man was referred to our department for endoscopic drainage of a pancreatic pseudocyst. He had acute pancreatitis as a result of choledocolithiasis, which developed following a cholecystectomy 2 years previously. Computed tomography (CT) revealed a 7-cm cystic lesion in the head of the pancreas, which was compatible with a pseudocyst. Endoscopic ultrasonography (EUS) was performed and showed a 7-cm homogeneous anechoic lesion. Under EUS guidance the lesionwas punctured using a 19-G needle through the posterior wall of the distal antrum (● Fig.1). After a guidewire had been passed into the cyst, cystotomywas performed. The access to the cyst was difficult, and during cystotomy ischemic changes were observed in the posterior wall andgreater curvature of the antrum (● Fig.2). The ischemia completely resolved after nearly 5 minutes. Complete cystotomy was achieved only after dissection of the fistula (● Fig.3) using a needleknife, which was inserted through an upper endoscope. Balloon dilation was performed, and two plastic 7-Fr doublepigtail stentswere placed● (Fig.4). The following day, the patient had fever and mild abdominal pain. CT scan showed the stent to be in a good position but an abscess was apparent between the stomach and the lesion, in the trajectory of the stent (● Fig.5). Antibiotic treatment with ciprofloxacin and metronidazole was initiated. Then, 3 days after the procedure, the patient experienced rectal bleeding, with a 4g/dL drop in hemoglobin levels (from 12.8 to 8.6g/dL). Upper endoscopy was performed, and showed a blood clot adherent to the stent, with no active bleeding. CT scan was repeated 1 week later, and showed resolution of the abscess. At this point, the patient resumed oral feeding and was discharged with no symptoms after 2 weeks of antibiotic treatment. Endoscopic drainage is an effective procedure for pancreatic pseudocyst [1]. Complications include stents migration, bleeding, perforation, and infection [2]. There have been no previous cases of gastric ischemia reported in the literature.

Endoscopic Ultrasound Directed Pseudocyst Drainage Without the Use of Fluoroscopy: A Case Series

Introduction: Endoscopic drainage of pancreatic pseudocysts is usually performed using fluoroscopy and a therapeutic duodenoscope. Endoscopic ultrasound (EUS) is often used to choose the puncture site and avoid penetrating a vessel. However, fluoroscopy and EUS equipment are typically in separate rooms making transport of EUS equipment difficult and cumbersome. Also, availability of a fluoroscopy suite can be an issue at many institutions. The aim of this study was to evaluate the technical feasibility and safety of EUS directed pseudocyst drainage without the use of fluoroscopy. Methods: Patients referred for pseudocyst drainage to one endosonographer between July 2005 and June 2015 were managed by cyst drainage using EUS guidance without the use of fluoroscopy. Technical success rate and complications were reviewed. In addition, previous attempts at drainage were recorded.17 procedures were performed using the Olympus GF-UC140P echoendoscope; 6 procedures were performed using Pentax therapeutic echoendoscope, 21 procedures were performed using Olympus therapeutic echoendoscope. In each case initial puncture was made using a 19G needle and fluid was aspirated. A .035 wire was passed through the needle into the cyst. The tract was dilated over the wire using a 4.5 to 6F graduated dilator; In 24 patients balloon dilation was then performed to 8 or 10 mm. 2 to 4 double pigtail stents were placed. Either 7Fx3cm or 5cm double pigtail stents were used. In 18 patients a 10 mmx4cm fully covered self expandable metal stent was placed (8 Wallflex & 10 Viabil stents). An ERCP trained nurse was required for the procedure. All procedures were performed only with a linear echoendoscope. Results: A total of 44 patients were managed with this technique. The procedure was unsuccessful in 1 of 44 patients due to difficulty with sedation. 5 patients had previous failed attempts at cyst drainage by ERCP experts using fluoroscopy and a therapeutic duodenoscope. EUS guided drainage was successful in all 5 of these patients. There were 4 complications: 1 patient had delayed bleeding requiring transfusion; this patient was known to have varices in the pseudocyst. 1 patient had stent migration into the cyst; this was removed at a later date without any untoward consequences. In 2 patients, one of the stents slipped out of the cyst; this was removed without any complications. Conclusion: EUS directed pseudocyst drainage without the use of fluoroscopy appears technically feasible and safe.

Mo1440 The Pure Endoscopic Drainage of Pancreatic Pseudocysts in Children - a Safe and Eficient Method - Case Series

Mo1440 The Pure Endoscopic Drainage of Pancreatic Pseudocysts in Children - a Safe and Eficient Method - Case Series

Current status of endotherapy for chronic pancreatitis.

Chronic pancreatitis is associated with varied morphological complications, including intraductal stones, main pancreatic ductal strictures, distal biliary strictures and pseudocysts. Endoscopic therapy provides a less invasive alternative to surgery. In addition, extracorporeal shockwave lithotripsy improves the success rate of endoscopic clearance of intraductal stones. However, recent data from randomised trials have shown better long-term outcomes with surgical drainage for obstructive pancreatic ductal disease. In patients with distal biliary strictures, stent insertion leads to good immediate drainage, but after stent removal, recurrent narrowing is common. Endoscopic drainage of pancreatic pseudocysts has excellent outcome and should be accompanied by pancreatic ductal stenting when a ductal communication is evident. In those who remain symptomatic, endoscopic ultrasonography-guided coeliac plexus block may provide effective but short-term pain relief. In this review, we present the current evidence for the role of endotherapy in the management of patients with chronic pancreatitis.

Metal Stenting Improves Endoscopic Drainage of Large Pancreatic Pseudocysts

Purpose: Stent placement in endoscopic drainage of pancreatic pseudocysts assures continuous cyst decompression and prevents early cystgastrostomy closure. Double pigtail plastic stents have been routinely used for this purpose; however, plastic stents may not provide adequate drainage in case of large (>10 cm) pseudocyst. We report our experience with fully covered metal stents for pancreatic pseudocyst drainage. Methods: Seven endoscopic cystgastrostomies with metal stent placement were performed between 2011 and 2013, and reviewed for procedure indication, cyst size, stent type and size, and complications. Results: All cystgastrostomies were endoscopic ultrasound guided. Abdominal pain was the most common indication for drainage; three patients had infected pseudocysts. Average patient age was 50 (35-65). Average cyst size was 15.9 cm (13-22 cm). Four 10 mm x 6 cm and three 10 mm x 8 cm fully covered metal biliary stents (Viabil, Gore) were used; in 5 out of 7 cases, plastic double pigtail stent was placed alongside metal stent. Average follow-up was 3.5 mo (1-6 mo). Pseudocysts resolved in all patients. There were no immediate complications; in one patient, metal stent migrated out into the stomach. Conclusion: In our experience, fully covered metal stents improve drainage of large pancreatic pseudocysts, leading to pseudocyst resolution with no immediate complications.Figure: Cystgastrostomy with metal stent.

Sa1536 A Meta-Analysis Comparing Transmural and Transpapillary Approaches of Endoscopic Pancreatic Pseudocyst Drainage: Is a Preferred Method Emerging?

Sa1536 A Meta-Analysis Comparing Transmural and Transpapillary Approaches of Endoscopic Pancreatic Pseudocyst Drainage: Is a Preferred Method Emerging?