Traditional Endoscopic EUS-Assisted vs. EUS only Drainage of Pancreatic Pseudocysts

Mangiavillano B, Arcidiacono PG, Carrara S, Mariani A, Masci E, Testoni PA

Division of Gastroenterology and Gastrointestinal Endoscopy,Vita-Salute San Raffaele University, San Raffaele Scientific Institute. Milan, Italy

ABSTRACT

Context A pancreatic pseudocyst (PP) is a cystic cavity within the pancreas surrounded by a granulation tissue wall. PP development is more commonly associated to acute or chronic pancreatitis. Therapeutic options are different but nowadays endoscopic treatment is considered the preferred technique. Echoendoscopy has recently been considered to overtake endoscopic part in PP treatment. Aim To assess the feasibility of endoscopic ultrasound (EUS) drainage of the PPs and to compare its feasibility, technical success and complications rates vs. EUS-assisted traditional endoscopic technique. Methods 14 patients (8 M; 6 F) undergone endoscopic PPs drainage with a median age of 55.7±21.5 years (range: 24-85 years) were retrospectively evaluated. Six patients were drained only by EUS; six patients with traditional endoscopic EUS-assisted technique, and two underwent diagnostic EUS and thereafter drained by ERCP because Wirsung communication with the PP. Results The median PPs diameter was 8.8±3.6 cm (range: 18-5 cm). In all of the 6 EUS drained patients we had technical success. Five patients(83.3%) underwent plastic stent placement throughout the cysto-gastrostomy (CGS). Four (80%) were double pig-tail, and one plastic straight (20%). In the last patient, the PP was aspirated by needle. In the five patients with plastic stent the CGS was created by a cystotome (CT); only in one a bugia dilatator was also used. One patient (16.7%) had hemorrhage (the patient in which bugia was used). Four patients (80%) had a cyst regression at 3 months follow-up; one (20%) had a PP recidive at 2 months (patient with straight stent). Of the 6 patients drained with traditional endoscopic EUS-assisted technique 4 (66.7%) had technical success while in 2 patients (33.3%) the previous positioned guide-wire under EUS guidance was displaced during the CT positioning with the duodenoscope. One patient (16.7%) had hemorrhage. Of the 4 patients with technical success 3 (75%) had a cyst regression at 3 months follow-up. Discussion EUS PPs drainage is an efficacy and safety methods if compared with traditional endoscopic EUS-assisted technique.

Congress Proceedings in PDF format