Post written by Wei An, MD, Dan Wang, MD, and Liang-Hao Hu, MD, from the Department of Gastroenterology, ChangHai Hospital, The Second Military Medical University, Shanghai, China.

A 69-year-old man with a history of chronic pancreatitis was referred to our hospital for severe abdominal distention and vomiting. Computed tomography revealed multiple pancreatic calcifications and a large tension pseudocyst in the pancreatic head that compressed adjacent organs. Single-step EUS-guided drainage of a pancreatic pseudocyst was performed. We modified a guidewire (COOK, Fusion LoopTip) with a loop tip as a cystotome, by shearing its terminal coating, bending, and plugging it into an electrosurgical unit. The loop tip was sleeved onto the inserted guidewire, and a nasocystic catheter was inserted next to the loop tip. Then, the cystogastrostomy tract was established and the nasocystic catheter was implanted simultaneously.

In EUS-guided drainage of pancreatic pseudocysts, the cystogastrostomy tract is usually established using a cystotome. After the cystotome is withdrawn,  a plastic stent or nasocystic catheter will be implanted. However, cystic fluid leakage could occur before implantation of stent or nasocystic catheter. This new 1-step EUS-guided drainage is easier to perform and can reduce the risk of leakage.

This single-step EUS-guided drainage of a pancreatic pseudocyst with a modified guidewire as a cystotome was safe and effective for pancreatic pseudocyst drainage and reduced the leakage of cyst fluid.

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