Drainage Of Pseudocysts Research Articles

Outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts by using combined endoprosthesis and a nasocystic drain

The presence of debris within a pseudocyst may impair success of endoscopic drainage. To compare the clinical outcomes and adverse-event rates of EUS-guided pseudocyst drainage with and without a nasocystic drain for the management of pancreatic pseudocysts with viscous solid debris-laden fluid. Retrospective study. Single, tertiary-care referral center. Consecutive patients with pancreatic pseudocysts managed by EUS-guided drainage: those with solid debris who underwent drainage via nasocystic drains alongside stents (n = 63) and those with solid debris who underwent drainage via transmural stents only (n = 24). Drainage via nasocystic drains alongside stents or drainage via transmural stents only. The primary outcomes were short-term success and long-term success of the procedures. The secondary outcomes were procedure-related adverse events and reintervention. The patients with viscous solid debris-laden fluid whose pseudocysts were drained by both stents and nasocystic tubes had a 3 times greater short-term success rate compared with those who had drainage by stents alone (P = .03). On 12-month follow-up, complete resolution of pseudocysts with debris drained via stents alone was less (58%) compared with those with debris who underwent drainage via nasocystic drains alongside stents (79%; P = .059). The rate of stent occlusion was higher in cysts with debris drained by stents alone (33%) compared with those drained via nasocystic drains alongside stents (13%; P = .03). Retrospective design; limited sample size. In patients with pseudocysts with viscous debris-laden fluid, EUS-guided drainage by using a combination of a nasocystic drain and transmural stents improves clinical outcomes and lowers the stent occlusion rate compared with those who underwent drainage via stents alone.

Endoscopic ultrasound procedures on panceatic fluid

Endoscopic ultrasound procedures on panceatic fluid

Mo1438 Relationship Between Stent Characteristics and Treatment Outcomes in Endoscopic Transmural Drainage of Pancreatic Pseudocysts

Mo1438 Relationship Between Stent Characteristics and Treatment Outcomes in Endoscopic Transmural Drainage of Pancreatic Pseudocysts

Su1578 EUS Guided Drainage of Pancreatic Pseudocyst and Walled off Liquefied Pancreatic Necrosis- Fully Covered Self-Expanding Metal Stent (Fcems) vs. Double Pigtail Plastic Stent for Cyst Gastrostomy

dedicated metal stent for PC. Herein, we’ll describe the results of EUS-guided pancreatic pseudocysts drainages (EUS-PCDs) with metallic stents (MS) in our hospital. Patients and Methods: EUS-PCDs with MS were performed in 28 cases at Tokyo medical university hospital, between January 2011 and November 2012. It included in those, like complicated pseudocysts, e.g. walled-off pancreatic necrosis.The mean of age was 53.7 14.4 years, the ratio of male to female was 24 : 4. The median diameter of cystic lesion was 108.2 37.0mm. The pancreatic pseudocyst was laocated in head (4), body (12) and tail (12). In all cases, needle puncture was performed via the stomach. The kinds of types of MS were normal biliary type (NB) in 1 case, dumbbell type (Yo-Yo stent) (D) in 20 cases and flared type (F) in 7 cases. If needed, endoscopic necrosectomy was added to perform. Result: The technical success rate of EUS-PCD with MS was 100% (28/28). Endoscopic necrosectomy following stent placement was performed in 16 cases. The clinical response rate of EUS-PCD with MS including combination with endoscopic necrosectomy was 100% (28/28). The complications were found 10.7% (3/28), and there is no fatal complication. The median procedure time was 33 minutes. The median stent removal time of MS was 40.4 days. The details of the complications were bleeding in 1, peritonitis in 1, displacement in 1. Conclusion: EUS-PCD with MS is effective procedure. In addition, MS appears to be safe and useful device for the management of complicated pseudocysts, e.g. walled-off pancreatic necrosis.

141 EUS-Guided Drainage of Pancreatic Pseudocysts (PP) Utilizing a Novel Anchoring, Covered Self-Expanding Metal Stent (Acsems): Results From a Prospective, Multi-Center Study

Logistic regression was conducted to evaluate the predictive factors for successful outcome and complications (Table 1). No factors were significantly associated with improved successful outcomes or low complication rates. Conclusion: Successful outcomes and safety profile are not different for gender, stricture type, extrahepatic or intrahepatic technique or stent placement route. Different techniques and approaches may be employed based on etiology, stricture location, and eventual altered anatomy emphasizing the need to individualize treatment for every case.

Sa1537 Outcomes of Endoscopic Ultrasound Guided Drainage of Pancreatic Pseudocysts With Debris Using Combined Endoprosthesis and Nasocystic Drain

Sa1537 Outcomes of Endoscopic Ultrasound Guided Drainage of Pancreatic Pseudocysts With Debris Using Combined Endoprosthesis and Nasocystic Drain

Su1577 Endoscopic Ultrasound-Guided Pancreatic Pseudocyst With Metal Stent Appears to Be Effective and Safe Procedure

Currently, endoscopic ultrasound (EUS) is used not only for observation but also therapeutic procedure. Many endoscopists reported that EUS-guided drainage for the pancreatic pseudocyst (PC) was useful and safe. Although single or multiple plastic stents are placed in this procedure, recently several endoscopists performed to place the biliary metal stent or dedicated metal stent for PC. Herein, we'll describe the results of EUS-guided pancreatic pseudocysts drainages (EUS-PCDs) with metallic stents (MS) in our hospital.

66 Creation of a Choledochoduodenostomy Using a Novel Lumenal Apposition Device: First Clinical Experience

Recently we reported on the feasibility and safety of transenteric drainage of pancreatic pseudocysts and gallbladders using a newly developed lumenal apposition device (GIE 2012). We now report on the first clinical experience of creation of a transenteric choledochoduodenostomy using the Lumenal Apposition Device (LAD).

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?

Su1648 A Comparison of the 2-Year Longitudinal Impact of Surgical Versus Endoscopic Pancreatic Pseudocyst Drainage on Healthcare Utilization and Morbidity

Su1648 A Comparison of the 2-Year Longitudinal Impact of Surgical Versus Endoscopic Pancreatic Pseudocyst Drainage on Healthcare Utilization and Morbidity

Pancreatic pseudocyst: spontaneous resolution by gastric erosion

A 49-year-old gentleman presented with upper abdominal discomfort, anorexia, and nausea of 4 weeks duration. Four months prior, he had received treatment in another hospital for severe epigastric pain. He admitted to consuming alcohol twice weekly, but had stopped after the previous episode of pain. Physical examination revealed a 12 cm × 10 cm nontender, nonmobile, epigastric lump. A contrast-enhanced computed tomography scan of the abdomen showed a welldefined pseudocyst of size 11.2 cm × 11.2 cm × 9.6 cm in the head, body, and neck of the pancreas displacing the distal stomach towards the right side (Fig. 1). One day prior to scheduled surgical drainage, he developed melena, and the abdominal lump resolved. An abdominal sonography showed marked reduction in the size of collection (from 600 to 30mL) with internal air foci. Gastroscopy showed an ulceronecrotic area in the body of the stomach with no active bleeding (Fig. 2). This patient had spontaneous gastric drainage of the pseudocyst. He remained well after 5 months, and declined further investigations. Spontaneous internal drainage of pseudocysts into the stomach is very rare due to its thick and well-perfused wall, [1] and the capacious lesser sac that provides room for decompression.

New devices and techniques for management of pancreatic fluid collections

New devices and techniques for management of pancreatic fluid collections

Efficacy, Safety, and Long-Term Follow-Up Results of EUS-Guided Transmural Drainage for Pancreatic Pseudocyst

Background and Aim. EUS-guided transmural drainage (EUS-GTD) is now considered a minimally invasive and effective alternative to surgery for drainage of symptomatic pancreatic pseudocysts. However, the technique is rather difficult, and sometimes serious complications occur to patients undergoing this procedure. We retrospectively evaluated efficacy, safety, and long-term follow-up results of EUS-GTD for pancreatic pseudocyst. Methods. Sixty-seven patients with pancreatic pseudocyst who underwent EUS-GTD from April 2000 to March 2011 were enrolled. We retrospectively evaluated (1) technical success, (2) clinical success, (3) adverse event of procedure, and (4) long-term follow-up results. Results. Total technical success rate was 88%. Ninety-one percent of external drainage, 79% of internal drainage, and 66% of puncture and aspiration only achieved clinical success. There was only one case with an adverse event, perforation (1.5%). The case required emergency operation. Total recurrence rate was 23.9%. Median follow-up period was 33.9 months. The recurrence rates in the cases of stent remaining, spontaneously dislodged, removed on schedule, external tube removal, and aspiration only were 10.0%, 12.5%, 42.9%, 50%, and 0%, respectively. Conclusion. EUS-GTD is a relatively safe and effective therapeutic method. However, further analysis should be done by larger series to determine the method of EUS-GTD for pancreatic pseudocyst.

Endoscopic drainage treatment of pancreatic pseudocysts.

This study presents the experience of its authors with endoscopic drainage treatment of pancreatic pseudocysts. The first part of the study offers a literature overview of the basic knowledge of pancreatic pseudocysts. The authors gradually deal with the individual types of pancreatic pseudocysts, the clinical picture, complications and diagnostics. Within the bounds of differential diagnostics the authors stress mainly the necessity of differentiating pancreatic pseudocysts from cystic tumors and benign cysts. Special attention is dedicated to various modalities of pancreatic pseudocyst treatment. The second part of the study presents the authors’ own results of the endoscopic drainage treatment of pancreatic pseudocysts. Results of endoscopic drainage treatment of pancreatic pseudocysts, which is one of significant possibilities of treatment of these conditions, are presented. This method was used to treat 33 patients (24 men and 9 women) from September 2007 to March 2009. Endoscopic drainage of pancreatic pseudocysts was performed four times transduodenally and 29 times transgastrically, of which 6 cases were under endosonographic guidance and 27 cases by a duodenoscopy after endosonographic targeting. The authors conclude that endoscopic drainage is an effective method of pancreatic pseudocyst treatment.

Endosonography-guided transmural drainage of pancreatic pseudocysts using an exchange-free access device: initial clinical experience

Endosonography (EUS)-guided transmural pseudocyst drainage is a multistep procedure currently performed with different "off-the-shelf" accessories developed for other applications. Multiple device exchanges over-the-wire is time consuming and risks loss of wire access. This report describes the technical feasibility and outcomes for EUS-guided drainage of pancreatic fluid collections using a novel exchange-free device developed for translumenal therapy. Between April and November 2010, 14 patients (9 men; mean age, 49.9 years) with pancreatic fluid collection (mean size, 102 mm) underwent 16 EUS-guided drainage procedures using the exchange-free access device at a single tertiary care center. The trocar of the exchange-free device was used to gain pseudocyst access. The dual-balloon catheter then was advanced over the trocar, followed by inflation of the (first) anchor balloon. Cyst contents were sampled, and contrast was injected to define the pseudocyst anatomy. The first guidewire was inserted into the cyst cavity. The cystenterostomy tract was dilated to 10 mm with the (second) dilation balloon, followed by a second guidewire insertion. The exchange-free access device was removed, leaving the two guidewires in place for two double-pigtail stents. The procedure was technically successful for all the patients. No acute procedure-related complications occurred. Late complications included a symptomatic leak in a patient who underwent drainage of a pancreatic uncinate pseudocyst from the second duodenum, a self-limited transfusion-dependent bleed after transbulbar drainage, and symptomatic pseudocyst infection. Pseudocyst access, cystenterostomy tract dilation, and placement of two guidewires for dual stent drainage are technically feasible using an exchange-free access device. The device has the potential to standardize, simplify, and streamline EUS-guided pseudocyst drainage with a single instrument. Comparative studies with alternative tools and methods for pseudocyst drainage are warranted.

Endoscopic Transmural Drainage of Pancreatic Pseudocysts: Technical Challenges in the Resource Poor Setting

Although surgical drainage of pancreatic pseudocysts has been superseded by less invasive options, the requirement for specialized equipment, technical expertise, and consumables limits the options available in low resource settings. We describe the challenges experienced during endoscopic transmural drainage in a low resource setting and the methods used to overcome these barriers. Despite operating in a low resource environment, endoscopic drainage of pancreatic pseudocysts can be incorporated into our armamentarium with minimal change to the existing hardware. Careful patient selection by a dedicated multidisciplinary team should be observed in order to achieve good outcomes.

Endoscopic management of chronic pancreatitis

Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.

Combined EUS-Guided Abdominal Cavity Drainage and Cystogastrostomy for the Ruptured Pancreatic Pseudocyst

Background. Endoscopic-Ultrasonography- (EUS-) guided puncture and drainage of pancreatic pseudocyst is currently one of the most widely accepted nonsurgical treatments. To date, this technique has only been used for pancreatic pseudocysts adhesive to the gastric wall. This study introduces the technique of EUS-guided pseudocyst drainage and additional EUS-guided peritoneal drainage for the ruptured pseudocyst. Methods. Transmural puncture and drainage of the cyst were performed with a 19 G needle, cystotome, and 10 Fr endoprosthesis. Intraperitoneal drainage was performed with a nasobiliary catheter when rupture of pseudocyst occurred. The entire procedure was guided by the echoendoscope. Results. A total of 21 patients, 8 men and 13 women, with a mean age of 36 years, were included in this prospective study. All of the pseudocysts were successfully drained by EUS. Peritoneal drainage was uneventfully performed in 4 patients. There were no severe complications. Complete pseudocyst resolution was established in all patients. Conclusion. The technique of EUS-guided transmural puncture and drainage, when combined with abdominal cavity drainage by a nasobiliary catheter, allows successful endoscopic management of pancreatic pseudocysts without adherence to gastric wall.

Endoscopic Ultrasound-guided Drainage of Pancreatic Pseudocysts: Medium-Term Assessment of Outcomes and Complications.

Objective:Endoscopic ultrasound (EUS)-guided drainage is a widely used treatment modality for pancreatic pseudocysts (PPC). However, data on the clinical outcome and complication rates are conflicting. Our study aims to evaluate the rates of technical success, treatment success and complications of EUS-guided PPC drainage in a medium-term follow-up of 45 weeks.Materials and Methods:A retrospective review was conducted for 55 patients with symptomatic PPC from December 2005 to August 2010 drained by EUS. Medium-term follow-up data were obtained by searching their medical history or by telephonic interview.Results:A total of 61 procedures were performed. The symptoms that indicated drainage were abdominal pain (n = 43), vomiting (n = 7) and jaundice (n = 5). The procedure was technically successful in 57 of the 61 procedures (93%). The immediate complication rate was 5%. At a mean follow-up of 45 weeks, the treatment success was 75%. The medium term complications appeared in 25% of cases, which included three cases each of stent clogging, stent migration, infection and six cases of recurrence. There was no mortality.Conclusion:EUS-guided drainage is an effective treatment for PPC with a successful outcome in most of patients. Most of the complications require minimal invasive surgical treatment or repeated EUS-guided drainage procedures.

Intramural pseudocysts of the upper gastrointestinal tract.

Background:Intramural pseudocysts or pseudocysts occurring in the gastrointestinal tract (GIT) wall are rare and there is a paucity of data on their clinical features and management.Patients and Methods:We retrospectively evaluated patients with intramural pseudocysts seen at our institution over the past 6 years. Intramural location was confirmed either on surgery or endoscopic ultrasound (EUS). Depending upon the symptoms, their control with the conservative medical therapy and procedural consent, the patients underwent EUS guided single time aspiration of the pseudocyst or transmural drainage or transpapillary drainage or surgery.Results:A total of 9 patients with intra mural pseudocysts (male: n = 8; mean age ± SD: 39.3 ± 8.0 years; age range: 24-54 years; five patients having chronic and four patients having acute pancreatitis) were studied. The pseudocysts were located in the wall of the second part of the duodenum in five patients, in the gastric wall in three patients and in the lower esophageal wall in one patient. The size of the pseudocysts ranged from 8 mm to 8 cm and 3/9 (33%) patients had associated extra mural pancreatic pseudocysts. All patients had abdominal pain on presentation. Along with pain the patients with duodenal intramural pseduocysts also had symptoms suggestive of gastric outlet obstruction (3) or jaundice (1). The patient with esophageal intramural pseudocyst had dysphagia along with abdominal pain. Majority of these patients could be successfully treated endoscopically with no significant complications.Conclusions:Intramural pseudocysts of the upper GIT are very rare and EUS is a useful investigational modality for diagnosing and treating them.