title: A novel method for performing multiple wire insertions during endoscopic cyst gastrostomy.
abstract: BACKGROUND
  Endoscopic cyst gastrostomy is effective in the management of uncomplicated pancreatic pseudocysts. A challenging aspect of the procedure is the insertion and confirmation of at least 2 guidewires into the cyst. Many technical procedures to accomplish the wire insertion have been described but are complicated.
  
  
  OBJECTIVE
  We describe the use of a simple commercially available catheter that allows multiple wires to be inserted into a pancreatic pseudocyst as an efficient and simple means of performing a cyst gastrostomy.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Academic referral center.
  
  
  METHODS
  Four consecutive patients undergoing EUS-guided cyst gastrostomy.
  
  
  METHODS
  A Haber ramp was used as the means for the introduction of multiple wires into a pancreatic pseudocyst.
  
  
  METHODS
  Technical success without loss of wire access during the cyst gastrostomy.
  
  
  RESULTS
  Four patients underwent successful pancreatic cyst gastrostomy. There was no loss of wire access during the procedure. There were no intraprocedure or postprocedure complications.
  
  
  CONCLUSIONS
  Small patient population.
  
  
  CONCLUSIONS
  The use of the Haber ramp provides a simple and efficient means for introducing, ensuring, and maintaining wire access during the creation of an endoscopic cyst gastrostomy.
authors.affiliation: Division of Gastroenterology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA. georg.spaun@gmail.com
authors.forename: John A
authors.initials: JA
authors.lastname: Evans
authors.forename: Jason D
authors.initials: JD
authors.lastname: Conway
authors.forename: Girish
authors.initials: G
authors.lastname: Mishra
mesh_terms: D002404:Catheterization; D016099:Endoscopy, Gastrointestinal; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010192:Pancreatic Pseudocyst / Q000601:surgery*