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TRANSGASTRIC DRAINAGE OF PANCREATIC PSEUDOCYSTS BY A NOVEL “ONE-STEP” ENDOSONOGRAPHIC TECHNIQUE
RL Barclay1, M Giovannini2, C Pesenti2, A-L Rolland2
1GI Diseases Research Unit, Queen’s University, Kingston, Ontario; 2Institut Paoli-Calmettes, Marseille, France
BACKGROUND: An endoscopic ultrasound (EUS)-guided approach to pancreatic pseudocyst drainage is gaining favour but this procedure can be technically demanding. We treated patients with symptomatic pancreatic pseudocysts via EUS-guided transgastric drainage using a novel and simplified single-step technique.
METHODS: Three patients (mean age 50) underwent EUS with a PentaxÒ FG-38 UX linear echoendoscope to characterize pseudocyst location and to perform cystogastrostomy. Pseudocysts (mean diameter 7 cm) pressed extrinsically on the posterior stomach without endoscopically appreciable mural bulging. The prototype puncture/drainage apparatus consisted of a guidewire sheath, a core metal wire with a retractable needle knife tip, a plastic supporting catheter, an 8.5 French plastic drainage endoprosthesis, and an outer pushing sleeve. Following EUS-guided transgastric pseudocyst puncture, guidewire-assisted placement of the endoprosthesis was performed without intervening exchange of wires or endoscopes.
RESULTS: Transgastric drainage of pseudocysts using the new technique was successful in all patients. There were no complications and the average duration of the procedure was 25 minutes. Follow-up at one month showed significant clinical and radiological improvement in all patients.
CONCLUSIONS: This series demonstrates the successful use of a novel and simplified “one-step” method of EUS-guided pseudocyst drainage using a prototype catheter device.