EUS-guided pancreatic pseudocyst drainage.
BACKGROUND
Endoscopic ultrasound-guided pancreatic pseudocyst drainage (EUS-PPD) has recently become popular. However, this technique has not yet been standardized, and the available instruments have not been sufficiently developed. Therefore, it is difficult to determine the treatment strategy and the choice of devices.


OBJECTIVE
To evaluate the current status of EUS-PPD.


METHODS
Between May 2001 and February 2008, EUS-PPD was attempted in 26 patients. Initially, an external drainage was placed, which was replaced with an indwelling tube in cases where the discharge continued more than 2 weeks. The early and late outcomes of EUS-PPD were retrospectively analyzed.


RESULTS
Placement of a naso-cystic drainage was successful in 24 (92%) of the 26 patients. Insertion of the drainage tube failed in other 2 patients due to a thickened cystic wall. The pseudocyst was completely resolved after the placement in 23 patients, while the remaining patient underwent a surgical operation. Discharge of the cystic fluid was stopped and the naso-cystic tube was removed in 12 patients after a median duration of 14.5 days. In the remaining 11 patients, it was replaced with indwelling tubes due to continuous discharge after 2 weeks. Thereafter, the indwelling tubes were removed in all cases after a median duration of 4 months. Recurrence of the pseudocyst occurred in 4 patients during a median follow-up period of 48 months. All 15 patients without cystic infection were successfully treated by EUS-PPD, and 9 (60%) of them were treated by only an external drainage. On the other hand, one patient (11%) failed treatment by EUS-PPD and 5 patients (56%) required subsequent internal drainage among the 9 patients with cystic infection.


CONCLUSIONS
Endoscopic ultrasound-guided pancreatic pseudocyst drainage is a promising treatment for a pancreatic pseudocyst. However, the insertion of the tube is difficult in cases with a thickened cystic wall. Infected pseudocysts are often difficult to treat by only short-term external drainage, thus additional treatments should be considered at an early stage.
Yasuda
Ichiro
I
First Department of Internal Medicine, Gifu University Hospital, Japan. YASUDAIC@aol.com
Iwata
Keisuke
K
Mukai
Tsuyoshi
T
Iwashita
Takuji
T
Moriwaki
Hisataka
H
D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional