Endoscopy 2006; 39 - FR04
DOI: 10.1055/s-2006-947743

Single-Step EUS-guided Pancreatic Pseudocyst Drainage using a Large Channel Linear Array Echoendoscope and Cystotome: Results in 10 Patients

S Ahlawat 1, A Charabaty Pishvaian 1, P Jackson 1, N Haddad 1
  • 1Georgetown University Hospital, Washington, US

Background: EUS-guided transmural drainage of pancreatic pseudocyst (PPC) has been reported with linear array echoendoscope; however, placement of larger stents (such as 10 French stent) was not feasible because of the limited diameter of the working channel until echoendoscopes with large working channel have become available. We describe a 1-step real time EUS-guided PPC drainage approach using a 3.8mm channel linear array echoendoscope (Pentax, Montvale, NJ) and cystotome (Wilson-Cook, Winston-Salem, NC).

Patients and Methods: Ten patients underwent EUS-guided PPC drainage. All patients were symptomatic or their PPC had failed to resolve in 6 weeks. A total of 11 procedures were performed from August 2004 to May 2005. In all patients the endoscopic therapy was preceded by abdominal imaging such as computerized tomography (CT) or transabdominal ultrasonography. All procedures were performed using a new large channel therapeutic linear array echoendoscope (EG-3830UT, Pentax, Montvale, NJ), Hitachi EUB 6500 ultrasound processor and a new accessory device cystotome (Wilson Cook, Winston-Salem, NC).

Results: EUS-guided PPC drainage was successful in all 10 patients; no major complication occurred. Placement of 1 or 2 10 French stents was successful in all patients who were considered eligible for EUS-guided PPC drainage. Two recurrences were noted over a mean follow-up period of 4 months (range 3–6 months). Both patients who had recurrence were found to have migrated stents. One patient underwent surgical cystgastrosotmy because of organized cyst contents and possible cyst infection. The 2nd patient was treated successfully with repeat EUS-guided PPC drainage.

Conclusion: A single-step approach using a large channel (3.8mm) therapeutic echoendoscope with an elevator is effective. The use of cystotome allows 1-step cyst puncture and its enlargement that enables easier passage of balloon dilator catheter.