Endosonographic imaging of pancreatic pseudocysts before endoscopic transmural drainage

Abstract

Endosonographic imaging of pancreatic pseudocysts before endoscopic transmural drainage Fockens, P.; Johnson, T.G.; van Dullemen, H.M.; Huibregtse, K.; Tytgat, G.N.J. Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Background: Endoscopic drainage of pancreatic pseudocysts has become an established alternative to surgery. We performed endosonography before endoscopic drainage to find out whether detailed anatomic information would help in the selection of appropriate candidates and result in a reduction of complications. Patients and Methods: Between April 1992 and July 1995 endosonography was performed in 32 patients, referred for endoscopic pseudocyst drainage, to determine the minimal distance between the pseudocyst and the gut, to identify interposed vascular structures, and to determine the optimal site for drainage. Results: Endosonography failed to identify a pseudocyst in 3 patients and in 2 patients the lesion was inconsistent with a pseudocyst. In 7 patients transmural drainage was considered inappropriate: in 4 the distance between the gut and the cyst was too large, in 2 varices were present between the cyst and the gut, and in 1 patient normal pancreatic parenchyma was present between the cyst and the gut. In 20 patients endosonography was followed by ERCP, and in 19 endoscopic drainage was attempted. Transmural drainage was successful in 16 patients. Endosonography changed management in 37.5% of the patients. Conclusion: Endosonography provides essential information prior to endoscopic drainage of pseudocysts, leading to a change in therapy in one third of patients. (Gastrointest

An unusual case of relative polycythemia with complication of pseudocyst of pancreas

“…Pseudocyst can be aspirated under EUS guidance for differential diagnosis of mucinous cystic neoplasms. 8 Because of high bleeding risk, we did not perform a drainage procedure in our case. Primary significance of management of patient with relative polycythemia is to avoid complications like portal, hepatic and mesenteric vein thrombosis associated with this disease.…”

Pancreatic pseudocyst drainage guided by endoscopic ultrasound

“…Thus, based on the EUS findings, the management plan is changed in 5%-9% of patients since EUS identifies other cystic lesions misdiagnosed as pseudocysts [6][7][8] .…”

An unusual case of polycythemia vera with a complication of pancreatic pseudocyst

“…In the EUS, the pseudocyst appears with lack of septations and mural nodules; however, internal debris is seen frequently. Pseudocysts can be aspirated under EUS guidance for a differential diagnosis of mucinous cystic neoplasms (16,17). Because of the high bleeding risk and stability of the cyst size, we did not perform a drainage procedure in our case.…”