Utility of endoscopic ultrasonography in endoscopic drainage of pancreaticpseudocysts in selected patients

Objectives: To determine the effect of endoscopic ultrasonography (EUS) on endoscopic drainage of pancreatic pseudocysts and to determine patency with fistula dilation and placement of multiple stents. Patients and Methods: Between September 1995 and January 1999, 19 patients underwent endoscopic drainage of pancreatic pseudocysts, 17 of whom were as sessed by EUS before drainage. Radial EUS scanning was used to detect an op timal site of apposition of pseudocyst and gut wall, free of intervening ve ssels. A fistula was created with a fistulatome, followed by balloon dilati on of the fistula tract. Patency was maintained with multiple double pigtai l stents. The primary goal of this retrospective study was to determine whe ther EUS affected the practice of endoscopic drainage of pancreatic pseudoc ysts. Results: In 3 patients, drainage was not attempted based on EUS findings. I n the other 13 patients (14 pseudocysts), creation of a fistula was success ful on 13 occasions, and no immediate complications occurred. However, 1 pa tient subsequently developed sepsis that required surgery. All other patien ts were treated with balloon dilation, multiple stents, and antibiotics, wi th no septic complications. Of 14 pseudocysts (in 13 patients), 13 (93%) re solved. Conclusions: Results of EUS may alter management of patients considered for endoscopic drainage of pancreatic pseudocysts. Endoscopic ultrasonography was useful for selecting an optimal and safe drainage site. The combination of balloon dilation, multiple stents, and antibiotics appears to resolve p ancreatic pseudocysts without septic complications.