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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2016; 07(04): 137-143
DOI: 10.4103/0976-5042.195739
Original Article
Journal of Digestive Endoscopy

Nonfluoroscopic endoscopic ultrasound-guided transmural drainage of pancreatic pseudocysts at atypical locations

Surinder Singh Rana
Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Vishal Sharma
Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Ravi Sharma
Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Puneet Chhabra
Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Rajesh Gupta
1   Department of Gastroenterology, Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Deepak Kumar Bhasin
Departments of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations
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Publication History

Publication Date:
26 September 2019 (online)

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Abstract

Background: Pancreatic pseudocysts (PP) at atypical locations are a therapeutic challenge and are usually managed surgically. Objective: We evaluated safety and efficacy of nonfluoroscopic endoscopic ultrasound (NF-EUS)-guided transmural drainage in the management of PP at atypical locations. Patients and Methods: Retrospective analysis of 11 patients (all males; age range: 28–46 years) with PP at atypical locations who were treated with NF-EUS-guided transmural drainage during the last 18 months was done. Results: Four patients had intra/peri-splenic, three patients had mediastinal, three patients had intrahepatic, and one patient had renal PP. Nine patients had chronic pancreatitis whereas two patients had acute pancreatitis. Alcohol was the etiology of pancreatitis in ten patients. The size of PP ranged from 4 to 10 cm. All patients had abdominal pain, and two patients had fever whereas one patient with mediastinal PP also had dysphagia. NF-EUS-guided transmural drainage could be done successfully in all patients. 7 Fr transmural stent(s) was/were placed in six patients whereas single-time complete aspiration of PP was done in five patients. On endoscopic retrograde pancreatography, six patients had partial duct disruption whereas five patients had complete disruption. Bridging transpapillary stent (5 Fr) was placed in all patients with partial disruption. All PP healed in 10/11 (91%) patients within 2–4 weeks, and there has been no recurrence in 9 of these patients during a follow-up period of 4–18 months. One patient with splenic PP needed surgery for gastrointestinal bleed. Conclusion: PP at atypical locations can be effectively and safely treated with NF-EUS-guided transmural drainage.

Key words

Endosonography - pancreatitis - pseudocyst - stent
 

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