title: Single-step versus multi-step transmural drainage of pancreatic pseudocysts: the use of cystostome is effective and timesaving.
abstract: OBJECTIVE
  Pancreatic pseudocysts are a major complication of chronic and acute pancreatitis and often require endoscopic intervention. Endoscopic single-step and multi-step transmural drainage techniques have been reported in the literature. The aim of this study was to evaluate and compare technical results and clinical outcome rates of the single-step versus multi-step endoscopic ultrasonography (EUS)-guided endoscopic transmural drainage in patients with symptomatic pancreatic pseudocysts of >4 cm size.
  
  
  METHODS
  Retrospective study at an academic tertiary referral center.
  
  
  METHODS
  A total of 38 consecutive patients comprising 42 interventions were studied: 16 patients with pancreatic pseudocysts (18 interventions) had undergone single-step EUS-guided transmural cystostome drainage between 2007 and 2010. Results were compared with a cohort of 22 patients who had submitted to multi-step EUS-guided transmural drainage of pancreatic pseudocysts in 24 cases between 2005 and 2007.
  
  
  RESULTS
  The technical success rate for using the single-step procedure was 94% compared with multi-step procedure with 83% (n.s.). Primary clinical success rate was 88% for single-step drainage and 90% for the multi-step approach (n.s.). The mean procedure time was 36 ± 9 min in the single-step group compared with 62 ± 12 min for the multi-step access (p < 0.001).
  
  
  CONCLUSIONS
  The use of single-step cystostome appears useful in managing selected patients with symptomatic pancreatic pseudocysts as it is effective and timesaving.
authors.affiliation: Department of Medicine B, University of Muenster, Muenster, Germany.
authors.forename: Hauke Sebastian
authors.initials: HS
authors.lastname: Heinzow
authors.forename: Tobias
authors.initials: T
authors.lastname: Meister
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pfromm
authors.forename: Frank
authors.initials: F
authors.lastname: Lenze
authors.forename: Wolfram
authors.initials: W
authors.lastname: Domschke
authors.forename: Hansjoerg
authors.initials: H
authors.lastname: Ullerich
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004322:Drainage / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods