ENDOSONOGRAPHIC IMAGING OF PANCREATIC PSEUDOCYSTS BEFORE ENDOSCOPIC TRANSMURAL DRAINAGE

Background: Endoscopic drainage of pancreatic pseudocysts has become a n established alternative to surgery. We performed endosonography befo re endoscopic drainage to find out whether detailed anatomic informati on would help in the selection of appropriate candidates and result in a reduction of complications. Patients and Methods: Between April 199 2 and July 1995 endosonography was performed in 32 patients, referred for endoscopic pseudocyst drainage, to determine the minimal distance between the pseudocyst and the gut, to identify interposed vascular st ructures, and to determine the optimal site for drainage. Results: End osonography failed to identify a pseudocyst in 3 patients and in 2 pat ients the lesion was inconsistent with a pseudocyst. In 7 patients tra nsmural drainage was considered inappropriate: in 4 the distance betwe en the gut and the cyst was too large, in 2 varices were present betwe en the cyst and the gut, and in 1 patient normal pancreatic parenchyma was present between the cyst and the gut. In 20 patients endosonograp hy was followed by ERCP, and in 19 endoscopic drainage was attempted. Transmural drainage was successful in 16 patients. Endosonography chan ged management in 37.5% of the patients. Conclusion: Endosonography pr ovides essential information prior to endoscopic drainage of pseudocys ts, leading to a change in therapy in one third of patients.