Endoscopic ultrasound-guided transpapillary drainage of a pancreatic pseudocyst

Background and objective: Endoscopic drainage of a pancreatic pseudocyst is an alternative to surgical intervention. But transmural drainage carries t he risk of bleeding or perforation. Effectiveness and complication rate of endoscopic ultrasound-guided drainage, to avoid these risks, was investigat ed. Patients and methods: Eleven patients (eight men, three women; mean age 55 years) with a pancreatic pseudocyst (nine with alcoholic and two with bilia ry pancreatitis) were studied prospectively between 1996 and 1998. In all o f them transpapillary drainage of the cyst had not been technically possibl e. After an endoscopic ultrasound (EUS) examination, the gastric wall was i ncised with a fistulotome under EUS guidance. A guide-wire was then advance d through the fistulotome into the pseudocyst. A double pigtail catheter wa s implanted for drainage. The size of the pseudocyst was monitored sonograp hically at two-week intervals. Results: A cystogastrostomy was successfully established in ten of the twel ve patients without serious complication. The pseudocyst was no longer demo nstrated after a mean of 4.2 months (2 weeks to 6 months), while a small ps eudocyst (1.6 cm [0.9-2.4 cm) remained in three patients. In two of the lat ter the size of the pseudocyst increased again after removal of the drainag e catheter. Complete drainage by repeat cystogastrostomy succeded in one of them, while a cystojejunostomy was established in the other. Conclusion: Endoscopic ultrasound-guided transgastric drainage of a pancrea tic pseudocyst is an effective treatment with few complications.