EUS-guided Pseudocyst Drainage Research Articles

EUS-guided transjejunal pancreatic pseudocyst drainage in a patient who underwent totalgastrectomy with roux-en Y anastomosis

EUS-guided transjejunal pancreatic pseudocyst drainage in a patient who underwent totalgastrectomy with roux-en Y anastomosis

EUS-guided pseudocyst drainage as a one-step procedure using a novel multiple wire insertion technique

EUS-guided pseudocyst drainage as a one-step procedure using a novel multiple wire insertion technique

PRESENT STATUS AND FUTURE PERSPECTIVE OF EUS‐GUIDED DRAINAGE

Development of the curved linear (convex) array echoendoscope has enabled procedures that utilize interventional endoscopic ultrasonography (EUS), such as EUS-guided drainage. EUS-guided pseudocyst drainage creates a fistula between the pseudocyst and the gastric or duodenal lumen. This treatment is superior to conventional endoscopic transmural drainage with respect to prevention from complications such as bleeding, because ultrasonographic observation permits easy visualization of the interposing vessels and real-time visualization of needle procedure. Endoscopic ultrasonography-guided drainage can also be applied to pancreatobiliary drainage. In cases where endoscopic retrograde cholangiopancreatography (ERCP) is unsuccessful in the treatment of obstructive jaundice and chronic obstructive pancreatitis, transmural drainage of bile and pancreatic juice under EUS guidance may supplant the percutaneous transhepatic biliary drainage and the surgical treatment.

CURRENT STATUS AND FUTURE PERSPECTIVE OF INTERVENTIONAL ENDOSCOPIC ULTRASOUND IN JAPAN

Vilmann and Grimm made the first reports of endoscopic ultrasound (EUS)-fine needle aspiration (FNA), and since then EUS-FNA has become popular in the clinical fields, especially in Western countries. Furthermore interventional EUS such as pseudocyst drainage, EUS-guided biliary drainage, celiac plexus neurolysis, and dendritic cell injection, etc. have been introduced. We have investigated the current status and future perspectives of interventional EUS in Japan. Standardization of EUS-guided pseudocyst drainage has been achieved, but EUS-guided biliary dranage is still controversial, and EUS-fine needle injection (FNI) including EUS-celiac plexus neurolysis (CPN) and dendritic cell injection have been under investigation. In any case, EUS-FNA seems to be a promising future technique and new applications have to be invented.

Causation of Pancreatic Pseudocyst Is the Key Influential Factors for the Success of EUS-Guided Treatment: The Therapeutic Strategy for Pancreatic Pseudocyst Based On Causative Factors

Background: Pancreatic pseudocyst (PPc) can be divided into 3 types based on causative factors: type 1, acute post-necrotic pseudocyst; type 2, post-necrotic pseudocyst on chronic pancreatitis; and type 3, chronic pseudocyst (retention). Types 1 and 2 can be classified as post-necrotizing pseudocysts, and with the spread of inflammation outside pancreas, the omental sac that exists between pancreas and stomach itself forms a cystic cavity, resulting in pseudocyst. The gastric wall thus becomes a cystic wall, and EUS-guided pseudocyst drainage (EUS-CD) is safety indicated. Type 3 is basically an intrapancreatic cyst, and because the stomach is separate from cyst, EUS-CD may cause to leak the cyst contents into abdominal cavity. In recent years, a technique to debride/lavage of a cyst by inserting an endoscope via stomach has been reported, but whether it is required in all PPc is unclear. The aim of this study was to clarify the indications for EUS-CD based on causative factors. Methods: 31 patients with PPc >6 cm in diameter, including 7 with type-1, 20 with type 2, and 4 with type 3, were enrolled. As to therapy, the external drainage using a naso-biliary tube was performed to manage infections, the internal drainage using a stent between the cyst and stomach was employed if aspirated contents were serous. With external drainage, the tube was clamped 2 weeks after placement, and it was removed 3 days later if the cyst did not increase. Then, if the cyst increased, internal drainage was employed. (Results) Internal drainage was performed on 1 type-1 and 4 type-2 patients. External drainage was employed on 6 type-1, 16 type-2, and 4 type-3 patients. For these treatments, efficacy of EUS-CD for types 1, 2, and 3 was 57%, 90%, and 50%. In type-1, a small cyst remained in 3 patients who were treated using EUS-CD alone. In addition, in almost type-2, EUS-CD alone was sufficient to achieve favorable results. In 2 type-3, EUS-CD alone was not enough, and surgical treatment was required. Regarding complications, in 1 type-2 patient and 2 type-3 patient, cystic contents leaked into the abdominal cavity during the procedure. (Conclusions) In the treatment of type-1, debridement / lavage of cyst via the stomach are appropriate. In type-2, management using a drainage tube is appropriate. Furthermore, in type-3, management using a drainage tube is pertinent if the cystic wall adheres to the gastrointestinal wall due to inflammation, but no therapy should be sufficient if no inflammation is present because of no adherence between cyst and stomach. The present study was retrospective, but demonstrates the importance of planning therapy based on pseudocyst type.

Advanced Translumenal Access Device for Pseudocyst Drainage

Introduction: EUS-guided pseudocyst drainage provides internal drainage without the need for surgical intervention. Current methods require multi-step access through the GI lumen wall into the pseudocyst, creation of a cystgastrotomy tract, and placement of multiple 7-10F plastic stents. Access and dilation steps are often tedious and difficult to perform due to the lack of a suitable stent delivery devices. Herein we describe a fully integrated translumenal access device that creates and dilates an access tract, then facilitates placement of two guidewires.

Current Status of Endoscopic Ultrasonography

Endoscopic ultrasound (EUS) has become the most accurate imaging modality for the gallbladder/bileduct/liver and locoregional cancer staging of the gastrointestinal tract.Fine-needle aspiration (FNA) has added a new level of accuracy for EUS in nodal staging, with reported numbers in the 90% range for luminal and pancreaticobiliary disease. In addition, new non-gastrointestinal applications are being evaluated, such as the role of EUS-FNA for the staging of non-small-cell lung cancer and exploration of the posteriormediastinum.Furthermore, the same techniques that makes safe tissue sampling possible are being explored for their use as interventional applications, such as EUS-guided celiac plexus neurolysis, fine-needle injection, EUSguided pseudocyst drainage, and EUS-guided cholangiography and pancreatography.This review describes the current clinical status of EUS in gastrointestinal and pancreatobiliary diseases as well as future and novel indications and therapeutic strategies for this technology.

Technology Insight: current status of endoscopic ultrasonography

Endoscopic ultrasound (EUS) has become the most accurate imaging modality for locoregional cancer staging of the gastrointestinal tract. Fine-needle aspiration (FNA) has added a new level of accuracy for EUS in nodal staging, with reported numbers in the 90% range for luminal and pancreaticobiliary disease. In addition, new non-gastrointestinal applications are being evaluated, such as the role of EUS-FNA for the staging of non-small-cell lung cancer and exploration of the posterior mediastinum. Furthermore, the same techniques that make safe tissue sampling possible are being explored for their use as interventional applications, such as EUS-guided celiac plexus neurolysis, fine-needle injection, EUS-guided pseudocyst drainage, and EUS-guided cholangiography and pancreatography. This review describes the current clinical status of EUS in gastrointestinal oncology, as well as future and novel indications and therapeutic strategies for this technology.

Endosonography-guided pseudocyst drainage

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.