title: Single-step EUS-guided pancreatic pseudocyst drainage using a large channel linear array echoendoscope and cystotome: results in 11 patients.
abstract: BACKGROUND
  EUS-guided transmural drainage of pancreatic pseudocyst has been reported using a linear array echoendoscope; however, placement of large 10 French stent was not feasible because of the limited diameter of the working channel. Recently linear array echoendoscopes with large working channel (3.7 to 3.8 mm) and newer accessories for pancreatic cyst puncture have become available; however, clinical data on their efficacy and safety in pancreatic pseudocyst drainage is not available.
  
  
  OBJECTIVE
  To evaluate efficacy and safety of a one-step real time EUS-guided pancreatic pseudocyst drainage approach using a 3.8 mm channel linear array echoendoscope and cystotome.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  Tertiary care hospital endoscopy unit.
  
  
  METHODS
  A total of 12 EUS-guided pancreatic pseudocyst drainage procedures were performed in 11 patients with symptomatic pancreatic pseudocyst using a 3.8 mm channel linear array echoendoscope and cystotome.
  
  
  METHODS
  Complete resolution of pancreatic pseudocyst on imaging.
  
  
  RESULTS
  Successful puncture of pancreatic pseudocyst and placement of 1 or 2 stents (10 Fr) was successful in all patients who were considered eligible for EUS-guided pancreatic pseudocyst drainage. Overall 9 patients out of a total of 11 (82%) were managed successfully with EUS-guided pseudocyst drainage. Two recurrences were noted over a mean follow-up period of 4 months (range 3-6 months). One patient underwent successful repeat drainage and the other patient was managed with surgical cystogastrostomy because of infected cyst contents. No major complication occurred.
  
  
  CONCLUSIONS
  Uncontrolled, small sample size.
  
  
  CONCLUSIONS
  A single-step approach using a large channel (3.8 mm) linear array echoendoscope and cystotome appears feasible. This approach appears safe and effective in managing selected patients with symptomatic pancreatic pseudocysts.
authors.affiliation: Division of Gastroenterology, Department of Surgery, Georgetown University Hospital, Washington, DC 20007, USA.
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Ahlawat
authors.forename: Aline
authors.initials: A
authors.lastname: Charabaty-Pishvaian
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Jackson
authors.forename: Nadim G
authors.initials: NG
authors.lastname: Haddad
mesh_terms: D000328:Adult; D000368:Aged; D003559:Cystostomy / Q000295:instrumentation*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D020776:Endoscopes, Gastrointestinal; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging* / Q000601:surgery*; D011183:Postoperative Complications; D012008:Recurrence