title: Outcomes of EUS-guided drainage of debris-containing pancreatic pseudocysts by using combined endoprosthesis and a nasocystic drain.
abstract: BACKGROUND
  The presence of debris within a pseudocyst may impair success of endoscopic drainage.
  
  
  OBJECTIVE
  To compare the clinical outcomes and adverse-event rates of EUS-guided pseudocyst drainage with and without a nasocystic drain for the management of pancreatic pseudocysts with viscous solid debris-laden fluid.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Single, tertiary-care referral center.
  
  
  METHODS
  Consecutive patients with pancreatic pseudocysts managed by EUS-guided drainage: those with solid debris who underwent drainage via nasocystic drains alongside stents (n = 63) and those with solid debris who underwent drainage via transmural stents only (n = 24).
  
  
  METHODS
  Drainage via nasocystic drains alongside stents or drainage via transmural stents only.
  
  
  METHODS
  The primary outcomes were short-term success and long-term success of the procedures. The secondary outcomes were procedure-related adverse events and reintervention.
  
  
  RESULTS
  The patients with viscous solid debris-laden fluid whose pseudocysts were drained by both stents and nasocystic tubes had a 3 times greater short-term success rate compared with those who had drainage by stents alone (P = .03). On 12-month follow-up, complete resolution of pseudocysts with debris drained via stents alone was less (58%) compared with those with debris who underwent drainage via nasocystic drains alongside stents (79%; P = .059). The rate of stent occlusion was higher in cysts with debris drained by stents alone (33%) compared with those drained via nasocystic drains alongside stents (13%; P = .03).
  
  
  CONCLUSIONS
  Retrospective design; limited sample size.
  
  
  CONCLUSIONS
  In patients with pseudocysts with viscous debris-laden fluid, EUS-guided drainage by using a combination of a nasocystic drain and transmural stents improves clinical outcomes and lowers the stent occlusion rate compared with those who underwent drainage via stents alone.
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors: Ali A
authors: AA
authors: Siddiqui
authors: John M
authors: JM
authors: Dewitt
authors: Anna
authors: A
authors: Strongin
authors: Harkirat
authors: H
authors: Singh
authors: Smoker
authors: S
authors: Jordan
authors: David E
authors: DE
authors: Loren
authors: Thomas
authors: T
authors: Kowalski
authors: Mohamad A
authors: MA
authors: Eloubeidi
mesh_terms: D000368:Aged; D020420:Cyst Fluid; D004322:Drainage / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010192:Pancreatic Pseudocyst / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*