Endoscopic management of pancreatic pseudocysts or abscesses after an EUS-guided 1-step procedure for initial access.
BACKGROUND
In this prospective case series, endoscopic management of pancreatic pseudocysts and abscesses was investigated following an EUS-guided 1-step procedure for initial transmural access.


METHODS
Endoscopic drainage of pancreatic pseudocysts and abscesses was performed in 35 patients (mean age, 51 years; range, 21-81 years) by using interventional echoendoscopes (FG38UX and EG3830UT; Pentax-Hitachi, Lübbecke, Germany). Interventions were performed by using a 1-step device consisting of a needle-wire suitable for cutting current, a 5.5F dilator, and an 8.5F plastic endoprosthesis (Giovannini Needle Wire Oasis, Cook Endoscopy, Winston-Salem, NC).


RESULTS
Endoscopic stent placement was successful in 33 of 35 patients (94%), whereas repeated needle passages were unsuccessful in 2 cases (pancreatic pseudocyst wall, 7 mm). No procedure-related complications, such as bleeding, perforation, or pneumoperitoneum, were observed. All subsequent complications, such as ineffective drainage (9%), stent occlusion (12%), or cyst infection (12%), were managed endoscopically. Fourteen patients (43%) demonstrated sustained clinical improvement and cyst resolution upon placement of the initial 8.5F transmural drain. Ten patients (30%) did not reveal a 50% reduction in cyst size on day 3, but cyst resolution was achieved by additional endoscopic cyst irrigation. Nine patients (27%) with primary or secondary cyst infection underwent endoscopic balloon dilation and prolonged endoscopic drainage procedures to achieve cyst resolution. The overall resolution rate was 88%, with a recurrence rate of 12%, based on a mean follow-up period of 24 months.


CONCLUSIONS
This 1-step EUS-guided technique with a needle-wire device provides safe transmural access and allows subsequent effective endoscopic management of pancreatic pseudocysts and abscesses.
Krüger
Martin
M
Department of Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule Hannover, Germany.
Schneider
Andrea S
AS
Manns
Michael P
MP
Meier
Peter N
PN
D000038:Abscess / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System; D019160:Endosonography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome