Retrograde Endoscopic Cystgastrostomy for Pancreatic Pseudocyst Drainage after a Prior Roux-en-Y Gastric Bypass

Abstract

A 47-year-old woman with a history of Roux-en-Y gastric bypass developed a pancreatic pseudocyst after an episode of acute necrotizing pancreatitis. She presented with intractable abdominal pain and weight loss. Computed tomography scan revealed an enlarging pancreatic fluid collection abutting the gastric antrum. The patient underwent exploratory laparotomy, at which a Whipple procedure was aborted due to severe fibrosis and necrosis of her pancreas. Retrograde peroral endoscopic pancreatic pseudocyst drainage was successfully performed through the defunctionalized stomach.

Endoscopic ultrasound training in mid-to-late career: Falling prey to the dark side or the bright side?

“…All the while, I relied on my motto as being “an interventional radiologist with an endoscope.” Pancreatic fluid collection drainage, even small size collections, could be identified and drained with knowledge of computed tomography anatomy and combined endoscopic, fluoroscopic orientation. [1234] Transmural drainage of nonpancreatic collections without EUS was also feasible. [5678] Biliary cannulation rarely failed, even with the postsurgical anatomy.…”