Single-step endoscopic ultrasonography-guided drainage of peripancreatic fluid collections with a single self-expandable metal stent and standard linear echoendoscope

Endoscopic ultrasonography (EUS)-guided drainage of peripancreatic fluid collections (PFCs) is a well described alternative to surgery or percutaneous drainage. However, it is limited by the requirement for a large working channel that allows multiple plastic stent placement, which is only commercially available on therapeutic linear echoendoscopes. Herein, we describe the drainage of PFCs with a single self-expandable metal stent (SEMS) using a single-step technique and standard linear echoendoscope. Seven cases were identified during a retrospective chart review, and included all patients who had undergone EUS-guided drainage of PFCs during a 6-month period. The mean age was 46 years (range 25 – 70 years) and all patients were symptomatic. The mean diameter of PFCs was 8 cm (range 4.1 – 12.5 cm). Previous percutaneous drainage had failed in three patients. A total of 10 PFCs were drained. Three patients had two cysts drained by the same stent and one patient had two separate procedures to drain two distinct cysts. The SEMS was in place for a mean of 13 weeks (range 4 – 34 weeks). Successful placement of SEMS was achieved in all seven cases. Patients were followed for a mean of 18 weeks (range 7 – 35 weeks), and symptom improvement was achieved in all cases. Complete resolution of PFC was achieved in 9 /10 cysts. No complications were encountered. Single-step EUS-guided drainage of PFCs using a single 10-mm SEMS and a standard linear echoendoscope appears to be a feasible endoscopic technique with excellent technical and clinical success rates.

• References

• 1 Lawson JM, Baillie J. Endoscopic therapy for pancreatic pseudocysts. Gastrointest Endosc Clin N Am 1995; 5: 181-193
• 2 Varadarajulu S, Wilcox CM, Tamhane A et al. Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage. Gastrointest Endosc 2007; 66: 1107-1119
• 3 Seewald S, Ang TL, Teng KC et al. EUS-guided drainage of pancreatic pseudocysts, abscesses and infected necrosis. Dig Endosc 2009; 21: 61-65
• 4 Varadarajulu S, Tamhane A, Blakely J. Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: an assessment of outcomes and complications and technical proficiency (with video). Gastrointest Endosc 2008; 68: 656-666
• 5 Ahlawat SK, Charabaty-Pishvaian A, Jackson PG et al. Single-step EUS-guided pancreatic pseudocyst drainage using a large channel linear array echoendoscope and cystotome: results in 11 patients. JOP 2006; 7: 616-624
• 6 Kitano M, Sakamoto H, Komaki T et al. Present status and future perspective of EUS-guided drainage. Dig Endosc 2009; 21: 66-70
• 7 Baron TH, Morgan DE. Acute necrotizing pancreatitis. N Engl J Med 1999; 340: 1412-1417
• 8 Norton ID, Clain JE, Wiersema MJ et al. Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients. Mayo Clin Proc 2001; 76: 794-798
• 9 Tenner S, Sica G, Hughes M et al. Relationship of necrosis to organ failure in severe acute pancreatitis. Gastroenterology 1997; 113: 899-903
• 10 Fockens P, Johnson TG, van Dullemen HM et al. Endosonographic imaging of pancreatic pseudocysts before endoscopic transmural drainage. Gastrointest Endosc 1997; 46: 412-416
• 11 Seewald S, Groth S, Omar S et al. Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos). Gastrointest Endosc 2005; 62: 92-100
• 12 Vilmann P, Hancke S, Pless T et al. One-step endosonography-guided drainage of a pancreatic pseudocyst: a new technique of stent delivery through the echo endoscope. Endoscopy 1998; 30: 730-733
• 13 Talreja JP, Shami VM, Ku J et al. Transenteric drainage of pancreatic-fluid collections with fully covered self-expanding metallic stents (with video). Gastrointest Endosc 2008; 68: 1199-1203
• 14 Cremer M, Deviere J, Engelholm L. Endoscopic management of cysts and pseudocysts in chronic pancreatitis: long-term follow-up after 7 years of experience. Gastrointest Endosc 1989; 35: 1-9
• 15 Belle S, Collet P, Post S et al. Temporary cystogastrostomy with self-expanding metallic stents for pancreatic necrosis. Endoscopy 2010; 42: 493-495