title: EUS-guided pancreatic pseudocyst drainage: simultaneous placement of stents and nasocystic catheter using double-guidewire technique.
abstract: BACKGROUND
  Endoscopic ultrasonography (EUS)-guided pancreatic pseudocyst drainage has become the standard and safety procedure in many centers for nonsurgical treatment. If multiple stents or another nasocystic catheter are used, the pseudocyst is recannulated using a catheter and guidewire. To avoid the cumbersome issue of recannulating the pseudocyst, we, and some endoscopists, have advocated the concept of a double-wire technique. The aim of this study is to evaluate EUS-guided simultaneous placement of stent and nasocystic catheter for pancreatic pseudocyst.
  
  
  METHODS
  Thirteen patients (9 men, mean age 55.7 years) underwent EUS-guided pancreatic pseudocyst drainage by simultaneous placement of stent and nasocystic catheter. Mean size of cyst was 81.3 +/- 63.1 (range; 35-280 cm). The symptoms that indicated a requirement for drainage in the 13 patients were abdominal pain (n = 8), fever (n = 4), and biliary obstruction (n = 1).
  
  
  RESULTS
  Transgastric and transduodenal approach were conducted in 10 cases and 3 cases, respectively. The procedure was technically successful in 12 of 13 patients (92%). At a median follow-up of 785 days, the treatment was successful in 13 of 13 patients (100%). No pseudocyst recurrence was observed. Decrease of cyst was seen in 8 cases (61.5%). Pseudocyst disappeared completely in 5 cases. There was no procedure-related complication.
  
  
  CONCLUSIONS
  Although more experience is required to determine whether this method is more effective, we believe that stent placement in combination with nasocystic catheter using double-wire technique will be of great value for patients with pancreatic pseudocysts without pancreatic necrosis.
authors.affiliation: Department of Gastroenterology and Hepatology, Tokyo Medical University, Japan. itoi@tokyo-med.ac.Jp
authors.forename: Takao
authors.initials: T
authors.lastname: Itoi
authors.forename: Fumihide
authors.initials: F
authors.lastname: Itokawa
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawai
authors.forename: Fuminori
authors.initials: F
authors.lastname: Moriyasu
mesh_terms: D000328:Adult; D000368:Aged; D002404:Catheterization / Q000379:methods; D002648:Child; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000628:therapy*; D015607:Stents; D016896:Treatment Outcome