Single-step EUS-guided drainage of a pancreatic pseudocyst with a modified guidewire as a cystotome

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.

Liang-Hao_headshot

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 After the cystotome is withdrawn,  a plastic stent or nasocystic catheter will be implanted.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.

Read the full 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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