title: One-step, simultaneous double-wire technique facilitates pancreatic pseudocyst and abscess drainage (with videos).
abstract: BACKGROUND
  EUS-guided pancreatic pseudocyst and abscess drainage ideally requires the insertion of both a transmural stent and nasocystic catheter to ensure continuous irrigation and effective drainage. Sequential stent and nasocystic catheter insertion may be time consuming because of the difficulty in recannulating the pseudocyst after the initial stent placement.
  
  
  OBJECTIVE
  Our purpose was to describe a novel one-step simultaneous double-wire technique that facilitates effective pancreatic pseudocyst and abscess drainage.
  
  
  METHODS
  To solve the problem of recannulating the pseudocyst cavity after the initial transmural stent placement, we developed a prototype 3-layer puncture kit that allows the simultaneous insertion of 2 guidewires at the initial puncture in one step. This puncture kit consists of a 22-gauge needle used for FNA, a 6F inner polytetrafluoroethylene (Teflon) catheter, and an outer 8.5F Teflon catheter.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Eight consecutive patients were treated.
  
  
  METHODS
  With use of a therapeutic linear echoendoscope and the assembled kit with the needle protruding out distally, the pseudocyst cavity was punctured by using electrocautery. The needle and the inner catheter were then withdrawn, leaving the outer catheter within the cavity. The size of this outer catheter permitted the simultaneous insertion of two 0.035-inch guidewires. Sequential insertion of a transmural stent and nasocystic catheter was then performed without a need for recannulation of the pseudocyst or abscess cavity.
  
  
  METHODS
  Successful endoscopic drainage.
  
  
  RESULTS
  All patients were successfully treated without complications. Mean procedural time was 32.5 minutes (range 25-45 minutes).
  
  
  CONCLUSIONS
  With this novel technique, establishing an irrigation system for the treatment of pancreatic pseudocysts and abscesses becomes easier, faster, and safer.
authors.affiliation: Department of Interdisciplinary Endoscopy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Seewald
authors.forename: Frank
authors.initials: F
authors.lastname: Thonke
authors.forename: Tiing-Leong
authors.initials: TL
authors.lastname: Ang
authors.forename: Salem
authors.initials: S
authors.lastname: Omar
authors.forename: Uwe
authors.initials: U
authors.lastname: Seitz
authors.forename: Stefan
authors.initials: S
authors.lastname: Groth
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhong
authors.forename: Emre
authors.initials: E
authors.lastname: Yekebas
authors.forename: Jakob
authors.initials: J
authors.lastname: Izbicki
authors.forename: Nib
authors.initials: N
authors.lastname: Soehendra
mesh_terms: D000038:Abscess / Q000150:complications / Q000628:therapy*; D044963:Biopsy, Fine-Needle; D002404:Catheterization; D002408:Catheters, Indwelling; D004322:Drainage; D016145:Endoscopy, Digestive System / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000150:complications / Q000601:surgery / Q000628:therapy*; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology / Q000628:therapy; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011677:Punctures; D015607:Stents; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
chemical_list: D011138:Polytetrafluoroethylene