Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts.
BACKGROUND
Single-step EUS-guided transmural drainage of pseudocysts has been reported, but there are no published prospective studies on clinical outcomes.


OBJECTIVE
To assess the safety and the efficacy of single-step EUS-guided placement of large endoprostheses to treat simple and complicated pseudocysts.


METHODS
Prospective cohort study.


METHODS
Single tertiary referral center.


METHODS
Consecutive patients referred for management of symptomatic chronic pancreatic pseudocysts >4 cm in size.


METHODS
Single-step EUS-guided transmural pseudocyst drainage performed with a linear-array echoendoscope for placement of 10F stents in adults and 7F stents in children.


METHODS
Complete or partial (>50% reduction) resolution of pseudocyst on follow-up imaging, recurrence, clinical response, and procedure-related complications. Recurrence was defined as the reappearance of a pancreatic pseudocyst in the same location.


RESULTS
There were 33 patients, with a mean age of 43 years. Median pseudocyst size was 8.5 cm (range, 4-20 cm). Fourteen patients (42%) had infected pseudocysts, 8 patients (24%) had gastric varices, and 16 patients (48%) had no visible endoscopic bulge. Stent placement was successful in 31 patients (94%). Twenty-seven patients (82%) had complete resolution of a pseudocyst; 4 patients (12%) had partial resolution, with symptom relief. There were 2 major complications and 3 minor complications. Recurrence of a pseudocyst was observed in only 1 patient over a median follow-up of 46 weeks.


CONCLUSIONS
No randomized treatment arm comparing this technique with conventional endoscopic drainage.


CONCLUSIONS
Single-step EUS-guided transmural drainage with large endoprostheses is a safe and effective therapy for patients with simple and complicated pancreatic pseudocysts.
Antillon
Mainor R
MR
Division of Gastroenterology and Hepatology, University of Colorado Health Sciences Center, Denver, Colorado 80010-0510, USA.
Shah
Raj J
RJ
Stiegmann
Gregory
G
Chen
Yang K
YK
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D019736:Prostheses and Implants