New MethodWire-guided pancreatic pseudocyst drainage by using a modified needle knife and therapeutic echoendoscope
Section snippets
Patients and methods
From December 1, 2002 to January 10, 2005, consecutive subjects with symptomatic pseudocysts in whom EUS-guided drainage was performed by using the technique described below were included in the analysis. Patients selected for endoscopic pseudocyst drainage were given nothing by mouth overnight. For all patients, informed consent was obtained, and parenteral antibiotics were administered. A therapeutic linear curved array echoendoscope with a 3.7-mm working channel, color and power Doppler
Results
Endoscopic pseudocyst drainage was attempted in 23 patients (17 men and 6 women; mean age, 54 years; range, 26-77 years). Eighteen patients (78%) had acute pancreatitis, 4 patients (17%) had immature pseudocysts, and 8 patients (35%) had debris in the pseudocyst by EUS.
With the exception of 2, all other patients underwent fluid aspiration for cell count, Gram stain, and culture to exclude infection. The fluid amylase level was checked in 13 of 23 patients to confirm the diagnosis of pseudocyst.
Discussion
Our method for endoscopic drainage of pancreatic pseudocysts by using EUS is a modification of previously described methods.2, 5, 7, 8, 9 By using the EUS wire-guided technique to avoid significant blood vessels, a pseudocyst can be safely and directly punctured. By initially passing the guidewire into the pseudocyst through the aspiration needle, the modified needle knife is wire guided, resulting in a controlled electrocautery application at the desired location and in the optimal direction.
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2016, Best Practice and Research: Clinical GastroenterologyCitation Excerpt :Additional efforts, like multiple stents or naso-cystic tube for external irrigation, may be required. Perforation has been reported as a complication in several reports (Fig. 1) [54–56,60]. Varadarajulu et al., evaluated for frequency of complications undergoing EUS-guided drainage of pancreatic fluid collections in 148 consecutive patients [65].
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Portions of this work were presented at the American Society for Gastrointestinal Endoscopy at Digestive Disease Week, New Orleans, Louisiana, May 15-20, 2004 (Gastrointest Endosc 2004;59:AB222).