Endosonography-guided transmural drainage of pancreatic pseudocysts using a one-step needle-wire device

Aims: In this open prospective study a one-step endoscopic ultrasound (EUS) guided technique using a needle-wire device was evaluated for safety and effectiveness of transmural endoscopic drainage of pancreatic pseudocysts (PPs).

Methods: Endoscopic drainage of PPs was performed in 35 patients (mean age 51 years, range 21–81 years) using interventional echo endoscopes FG38UX and EG–3830UT (Pentax-Hitachi). Interventions were performed using a one-step device consisting of a needle-wire suitable for cutting current, a 5.5 Fr dilator and a 8.5 Fr plastic endoprosthesis (Giovannini Needle Wire Oasis, Wilson-Cook Medical Inc.).

Results: Endoscopic stent placement was successful in 33 of 35 patients (94%), while in two cases, repeated needle passages were unsuccessful (PP wall 7mm). Fourteen patients (43%) demonstrated sustained clinical improvement and cyst resolution upon placement of a single 8.5 Fr transmural drainage. Ten patients (30%) did not reveal a 50% reduction in cyst size on day 3, but cyst resolution was acchieved by additional endoscopic cyst irrigation. Nine patients (27%) suffering from primary or secondary cyst infection underwent endoscopic balloon dilation and prolonged endoscopic drainage procedures to acchieve cyst resolution. The overall resolution rate was 88% with a recurrence rate of 12% and no procedure-related major complications (such as bleeding, perforation, pneumoperitoneum). Minor complications were: cyst infection (12%), stent occlusion (12%) or ineffective drainage (9%).

Conclusion: This one-step EUS-guided technique using a needle-wire device allows effective and safe transmural drainage of pancreatic pseudocysts.

Keywords: endoscopic drainage, endoscopic retrograde cholangio-pancreatography, endoscopic ultrasound, endosonography, pancreatic cysts, pancreatic pseudocyst, pancreatitis