One-Step Endosonography-Guided Drainage of a Pancreatic Pseudocyst: A New Technique of Stent Delivery Through the Echo Endoscope

Abstract

We report here the first case of a one-step endosonography(EUS)-guided pseudocyst drainage. A prototype large channel curved array echo endoscope (Pentax FG-38 UX) and a prototype delivery system for placement of an endoprosthesis was used for the procedure. The delivery system (GIP MedicinTechnik GmbH/Medi-Globe Corporation) consists of a handle part with a piston, a metal ring sheath, a plastic catheter with a diathermy needle and a double pigtail endoprosthesis (8.5 Fr). When mounted on the endoscope the endoprosthesis can be advanced out of the distal end of the endoscope. The introduction of the stent as well as the stent release can be monitored entirely by ultrasound. The procedure was tested in a 76-year-old woman with a pseudocyst measuring 60 mm in diameter located in the tail of the pancreas. The procedure was well tolerated by the patient, and there were no procedural complications. The advantage of a large channel echo endoscope and our new prototype delivery system is that the endoprosthesis can be inserted in to a pancreatic cyst guided exclusively by EUS without exchange of endoscopes, catheters or guide wires. Further studies are warranted.

Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety

“…6 The advantages of endoscopic drainage compared to percutaneous drainage include the ability to place multiple internal drains through one puncture site and the avoidance of development of a pancreaticocutaneous fistula in pseudocysts that communicate with the pancreatic duct. Single-step EUS-guided pseudocyst drainage was first described by Vilmann and colleagues 17 and Giovannini and associates. 18 This technique showed higher technical success rate compared to conventional method in previous reports.…”

Pancreatic pseudocyst drainage guided by endoscopic ultrasound

“…The single step technique was first described in 1998 by Vilmann et al [9] and Giovannini et al [10] . In a prospective study, Kruger and co-workers [11] evaluated the onestep device for drainage of pancreatic pseudocysts and abscesses (Giovannini Needle Wire Oasis, Cook Endoscopy, Limerick, Ireland).…”

Endoscopic treatment of chronic pancreatitis

“…Coeliac block is associated with a low morbidity (diarrhoea in 3.5% of cases) [25,26] . Treatment of pancreatic cysts under EUS guidance is dedicated for pseudo cysts which are not bulging in the gut [27][28][29][30][31][32] . In case of complete obstruction of the pancreatic duct, a pancreatico-gastrostomy can be achieved under EUS guidance [33,34] .…”

“…Transmural drainage is especially reserved to large cysts but must be avoided in presence of segmental portal hypertension. Results of EUS-guided pseudo-cysts drainage have been recently reported in six series including 69 cases [27][28][29][30][31][32] . The most important monocentric study included 35 patients of whom 20 pancreatic abscess: after 27 mo of follow-up, drainage was successful in 94% of cases, a pneuperitoneum occurred in a case and has been managed conservatively, recurrence of cyst occurred in three cases of whom two abscess, surgical drainage was necessary in four cases of whom were four abscess.…”