Wire-guided pancreatic pseudocyst drainage by using a modified needle knife and therapeutic echoendoscope.
BACKGROUND
Various methods to drain pancreatic pseudocysts by using EUS guidance have been reported in the literature.


OBJECTIVE
A new drainage technique is described that uses a modified needle knife advanced over a guidewire positioned in the pseudocyst by EUS guidance.


METHODS
Retrospective chart review.


METHODS
Academic medical center.


METHODS
Consecutive subjects from December 1, 2002, to January 10, 2005, with symptomatic pseudocysts in whom EUS-guided drainage was attempted.


METHODS
By using a therapeutic linear echoendoscope, a 19-gauge aspiration needle was inserted into the pseudocyst. A guidewire was placed through the needle, and a needle knife with the cutting wire protruding and bent was advanced over the guidewire to contact the stomach mucosa. The needle knife was then advanced by using electrocautery into the pseudocyst. The cystenterostomy was dilated by using a balloon over the guidewire. One to 4 stents were placed through the tract.


METHODS
Successful pseudocyst drainage.


RESULTS
A total of 21 of 23 patients underwent technically successful pseudocyst drainage. One patient had self-limited hypotension during the procedure. Another patient had free intraperitoneal air after the procedure but correct stent placement.


CONCLUSIONS
Retrospective analysis, small sample size.


CONCLUSIONS
In this preliminary experience, wire-guided pseudocyst drainage with a modified needle knife appears effective and safe while allowing for a more controlled pseudocyst puncture.
Azar
Riad R
RR
Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO 63110, USA.
Oh
Young S
YS
Janec
Eileen M
EM
Early
Dayna S
DS
Jonnalagadda
Sreenivasa S
SS
Edmundowicz
Steven A
SA
D000328:Adult; D000368:Aged; D004322:Drainage / Q000295:instrumentation*; D020776:Endoscopes, Gastrointestinal; D019160:Endosonography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome