Amy Tyberg, MD from Weill Cornell Medical College in New York, New York, USA presents this video case, “Tamponade of a bleeding pseudocyst with a fully covered metal stent.”

This video describes a case of an endoscopic-ultrasound (EUS) guided pseudocyst drainage that was complicated by bleeding into the cyst cavity seen on EUS imaging. The bleeding was controlled by placement of a fully-covered, self-expanding metal stent (FCSEMS) without the need for further intervention.

Figure 1. Endoscopic vision of the fully covered metal stent with tamponade of the bleeding.

Endoscopic cystgastrostomy is the preferred therapeutic option for management of pancreatic pseudocysts. Although using EUS with doppler analysis capabilities provides endoscopists with the ability to identify and avoid vascular structures between the cyst and the gastric lumen when performing this procedure, bleeding is still a known and not infrequently encountered complication. One means of controlling bleeding during cystgastrostomy is to tamponnade the bleeding vessel using a dilating balloon and a FCSEMS. The radial force from the balloon or from the FCSEMS can provide direct pressure to the bleeding vessel and help expedite clot formation. Thus, when bleeding occurs, the most important response is to continue the procedure by maintaining wire access and using a dilating balloon followed by a FCSEMS to tamponade bleeding rather than aborting the procedure. This action can often save the patient a second procedure for hemostasis, such as arteriography with embolization by interventional radiology or even surgical intervention.

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