title: EUS-guided pseudocyst drainage: prospective evaluation of early removal of fully covered self-expandable metal stents with pancreatic ductal stenting in selected patients.
abstract: BACKGROUND
  EUS-guided pseudocyst drainage with fully covered self-expandable metal stents (FCSEMSs) was recently described. The appropriate period for stent removal is not known.
  
  
  OBJECTIVE
  To assess the safety and efficacy of EUS-guided FCSEMS placement for 3 weeks, along with pancreatic ductal stenting in selected patients.
  
  
  METHODS
  Prospective, single-center evaluation.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Symptomatic pseudocysts in the body and tail region of the pancreas.
  
  
  METHODS
  EUS-guided transgastric placement of FCSEMS. MRCP was performed after 3 weeks. Patients with a suspected pancreatic duct leak underwent ERCP and plastic stent placement. The FCSEMSs were removed at 3 weeks.
  
  
  METHODS
  Success of FCSEMS placement, adverse events, and recurrence rate.
  
  
  RESULTS
  Forty-seven patients met the eligibility criteria. Technical and functional success was achieved in 43 patients (intention to treat, 91.48% and 95.34% patients [per protocol, 41/43, respectively]). Adverse events occurred in 2 patients (cyst infections, 4.6%). Follow-up of 42 patients at 3 weeks was performed. MRCP detected a ductal leak in 3 patients (7.1%) and a disconnected duct in 2 patients (4.7%). ERCP and stenting were successful in all 3 patients with a ductal leak. During a median follow-up of 306 days in 42 patients, 2 recurrences (4.7%) were detected, both in patients with disconnected duct. Multivariate analysis showed that pancreatic ductal leak or disconnection was an independent factor affecting pseudocyst resolution at 3 weeks (P = .0001).
  
  
  CONCLUSIONS
  Single-center study.
  
  
  CONCLUSIONS
  Short-term placement of FCSEMSs with pancreatic ductal stenting in selected patients appears safe and effective for the treatment of pseudocysts.
authors.affiliation: Department of Endoscopy and endosonography, Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Dhir
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
authors.forename: Anthony Yuen Bin
authors.initials: AY
authors.lastname: Teoh
authors.affiliation: Department of Endoscopy and endosonography, Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Mukta
authors.initials: M
authors.lastname: Bapat
authors.affiliation: Department of Endoscopy and endosonography, Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Suryaprakash
authors.initials: S
authors.lastname: Bhandari
authors.affiliation: Department of Endoscopy and endosonography, Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Joshi
authors.affiliation: Department of Endoscopy and endosonography, Baldota Institute of Digestive Sciences, Mumbai, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Maydeo
mesh_terms: D000328:Adult; D020878:Device Removal; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000628:therapy*; D018579:Patient Selection; D011446:Prospective Studies; D012008:Recurrence; D000069322:Self Expandable Metallic Stents; D016896:Treatment Outcome