Background and Aim. EUS-guided transmural drainage (EUS-GTD) is now considered a minimally invasive and effective alternative to surgery for drainage of symptomatic pancreatic pseudocysts. However, the technique is rather difficult, and sometimes serious complications occur to patients undergoing this procedure. We retrospectively evaluated efficacy, safety, and long-term follow-up results of EUS-GTD for pancreatic pseudocyst. Methods. Sixty-seven patients with pancreatic pseudocyst who underwent EUS-GTD from April 2000 to March 2011 were enrolled. We retrospectively evaluated (1) technical success, (2) clinical success, (3) adverse event of procedure, and (4) long-term follow-up results. Results. Total technical success rate was 88%. Ninety-one percent of external drainage, 79% of internal drainage, and 66% of puncture and aspiration only achieved clinical success. There was only one case with an adverse event, perforation (1.5%). The case required emergency operation. Total recurrence rate was 23.9%. Median follow-up period was 33.9 months. The recurrence rates in the cases of stent remaining, spontaneously dislodged, removed on schedule, external tube removal, and aspiration only were 10.0%, 12.5%, 42.9%, 50%, and 0%, respectively. Conclusion. EUS-GTD is a relatively safe and effective therapeutic method. However, further analysis should be done by larger series to determine the method of EUS-GTD for pancreatic pseudocyst. 1. Introduction Endoscopic ultrasonography guided transmural drainage (EUS-GTD) is now a widely reported and established procedure for drainage of symptomatic pancreatic pseudocyst. The technical success rate of this procedure has been reported to be more than 90% on the other hand, complication rate is less than 5% [1–5]. Severe adverse events such as bleeding or perforation sometimes occur, but in general, EUS-GTD has been recognized as a relatively safe and effective therapeutic method and is performed as a common procedure in many institutes. However, some factors including the long-term outcome, appropriate period of stenting, and timing of removing the stent have not been determined yet. 2. Patients and Methods Patient characteristics are described in Table 1. Sixty-seven patients with pancreatic pseudocyst who underwent EUS-GTD from April 2000 to March 2011 were enrolled. Indications of EUS-GTD at our center are as follows: symptomatic pancreatic cysts, infection or hemorrhage, rapid increase in size, and no communication with MPD. In this study, 3 cases after acute pancreatitis (type 1) had walled off necrosis. Abdominal
References
[1]
S. Varadarajulu, C. M. Wilcox, A. Tamhane, M. A. Eloubeidi, J. Blakely, and C. L. Canon, “Role of EUS in drainage of peripancreatic fluid collections not amenable for endoscopic transmural drainage,” Gastrointestinal Endoscopy, vol. 66, no. 6, pp. 1107–1119, 2007.
[2]
M. Krüger, A. S. Schneider, M. P. Manns, and P. N. Meier, “Endoscopic management of pancreatic pseudocysts or abscesses after an EUS-guided 1-step procedure for initial access,” Gastrointestinal Endoscopy, vol. 63, no. 3, pp. 409–416, 2006.
[3]
C. V. Lopes, C. Pesenti, E. Bories, F. Caillol, and M. Giovannini, “Endoscopic-ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts and abscesses,” Scandinavian Journal of Gastroenterology, vol. 42, no. 4, pp. 524–529, 2007.
[4]
M. R. Antillon, R. J. Shah, G. Stiegmann, and Y. K. Chen, “Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts,” Gastrointestinal Endoscopy, vol. 63, no. 6, pp. 797–803, 2006.
[5]
S. Varadarajulu, “EUS followed by endoscopic pancreatic pseudocyst drainage or all-in-one procedure: a review of basic techniques (with video),” Gastrointestinal Endoscopy, vol. 69, no. 2, pp. S176–S181, 2009.
[6]
R. Sadik, E. Kalaitzakis, A. Thune, J. Hansen, and C. J？nson, “Eus-guided drainage is more successful in pancreatic pseudocysts compared with abscesses,” World Journal of Gastroenterology, vol. 17, no. 4, pp. 499–505, 2011.
[7]
S. Varadarajulu, M. A. Phadnis, J. D. Christein, and C. M. Wilcox, “Multiple transluminal gateway technique for EUS-guided drainage of symptomatic walled-off pancreatic necrosis,” Gastrointestinal Endoscopy, vol. 74, no. 1, pp. 74–80, 2011.
[8]
S. Varadarajulu, A. Tamhane, and J. Blakely, “Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: an assessment of outcomes and complications and technical proficiency (with video),” Gastrointestinal Endoscopy, vol. 68, no. 4, pp. 656–666, 2008.
[9]
S. Seewald, T. L. Ang, M. Kida, K. Y. K. Teng, and N. Soehendra, “EUS 2008 Working Group document: evaluation of EUS-guided drainage of pancreatic-fluid collections (with video),” Gastrointestinal Endoscopy, vol. 69, no. 2, supplement, pp. S13–S21, 2009.
[10]
T. Itoi, F. Itokawa, T. Tsuchiya, T. Kawai, and F. Moriyasu, “Eus-guided pancreatic pseudocyst drainage: simultaneous placement of stents and nasocystic catheter using double-guidewire technique,” Digestive Endoscopy, vol. 21, supplement s1, pp. S53–S56, 2009.
[11]
R. Puri, S. R. Mishra, R. B. Thandassery, et al., “Outcome and complication of endoscopic ultrasound guided pancreatic pseudocyst drainage using combined endoprosthesis and naso-cystic drain,” Journal of Gastroenterology and Hepatology, vol. 27, no. 4, pp. 722–727, 2012.
[12]
S. Seewald, T. L. Ang, H. Richter, et al., “Long term results after endoscopic drainage and necrosectomy of symptomatic pancreatic fluid collection,” Digestive Endoscopy, vol. 24, pp. 36–41, 2011.
