EUS guided “pseudocystogram“: an adjunct to ERCP for performing endoscopic cystgastrostomy

Background: Endoscopic cystgastrostomy has become a well established therapeutic procedure for draining pancreatic pseudocysts. Endoscopic ultrasound has become invaluable in limiting post procedure complications-namely bleeding. We report a novel method for EUS assistance in performing cystgastrostomy.

Aims: To describe our centers experience in performing EUS-guided pseudocystogram prior to endoscopic cystgastrostomy.

Methods: Over a 1.5 yr period, 13 endoscopic cystgastrostomies were successfully performed. 10 of these had an endoscopic ultrasound performed using the Olympus therapeutic linear echoendoscope GFUCT 140 (Olympus America, Melville) under fluoroscopy. Using a 19-gauge Wilson-Cook needle, contrast dye was injected directly into the pseudocyst under endosonographic guidance and fluoroscopy. Our ERCP colleagues were then able to use this “pseudocytogram“ as a road-map for endoscopic localization and drainage with a side viewing duodenoscope.

Results: 4 females, 5 males (median age 18, range 18–85) successfully underwent a EUS-guided pseudocystogram (mean 7.8cm x 7.4cm; range 3.0cm-10.0cm) followed by endoscopic cystgastrostomy. In 1 patient, contrast could not be easily injected into the pseudocyst with poor delineation on fluoroscopy and thus, no cyst drainage was attempted. No immediate complications were noted.

Conclusion: EUS-guided pseudocystogram was obtained in 90%. This technique allows better delineation of the pseudocyst cavity under fluoroscopy so that endoscopic cystgastrostomy can be performed with greater success while minimizing risk. Until pseudocysts are uniformly drained by EUS, we suggest that this approach can be safely employed by therapeutic endoscopists to achieve maximal success.