EUS-guided pseudocyst drainage

Vinay Dhir, MD, FASGE, from the Baldota Institute of Digestive Sciences in Mumbai, India discusses this Original Article, “EUS-guided pseudocyst drainage: Prospective evaluation of early removal of fully covered self expandable metal stents with pancreatic ductal stenting in selected patients.”

The study focused on 2 aspects of pseudocyst drainage (PD). Firstly, whether it is possible to remove fully-covered self expandable stents (FCSEMSs) at an earlier time interval than the currently practiced interval of 8-12 weeks. Secondly, whether MRCP-based detection of pancreatic duct leak and subsequent placement of plastic stent for ductal leak reduces recurrence rates of pseudocysts.

There is no data on ideal time of removal of a FCSEMS placed for pseudocyst drainage. It is possible that, due to their larger diameter, FCSEMSs provide a more efficient drainage and can be removed early. Detection of PD leaks should allow for pancreatic duct stent placement for prevention of recurrence of pseudocysts. There are scant data in this regard, particularly the role of MRCP in the detection of such leaks.

Figure 2. Functional success. A, EUS appearance of a large (9 X 10 cm) pseudocyst before drainage. B, Abdominal US view 24 hours after fully covered self-expandable metal stent placement. The cyst size is reduced to 1.8 cm.

We found that FCSEMSs provided efficient drainage with 95.3% of pseudocysts regressing to <2 cm in size on ultrasonography examination at 24 hours. All but one patient had the FCSEMS removed at 3 weeks. MRCP detected ductal leak in 7.1% patients and a disconnected duct in 4.7% patients.  Pancreatic duct stenting was successful in all 3 patients with ductal leak. At a median follow up of 306 days, recurrence developed in 4.7% of patients, both of whom had disconnected duct.

Thus the strategy of early removal of FCSEMS and PD stenting in patients with PD leak appears to give decent results. However longer term follow up is needed as recurrences might develop even after one year.

Read the abstract for this article online.

The information presented in Endoscopedia reflects the opinions of the authors and does not represent the position of the American Society for Gastrointestinal Endoscopy (ASGE). ASGE expressly disclaims any warranties or guarantees, expressed or implied, and is not liable for damages of any kind in connection with the material, information, or procedures set forth.

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