Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts.

BACKGROUND

Single-step EUS-guided transmural drainage of pseudocysts has been reported, but there are no published prospective studies on clinical outcomes.

OBJECTIVE

To assess the safety and the efficacy of single-step EUS-guided placement of large endoprostheses to treat simple and complicated pseudocysts.

DESIGN

Prospective cohort study.

SETTING

Single tertiary referral center.

PATIENTS

Consecutive patients referred for management of symptomatic chronic pancreatic pseudocysts >4 cm in size.

INTERVENTIONS

Single-step EUS-guided transmural pseudocyst drainage performed with a linear-array echoendoscope for placement of 10F stents in adults and 7F stents in children.

MAIN OUTCOME MEASURES

Complete or partial (>50% reduction) resolution of pseudocyst on follow-up imaging, recurrence, clinical response, and procedure-related complications. Recurrence was defined as the reappearance of a pancreatic pseudocyst in the same location.

RESULTS

There were 33 patients, with a mean age of 43 years. Median pseudocyst size was 8.5 cm (range, 4-20 cm). Fourteen patients (42%) had infected pseudocysts, 8 patients (24%) had gastric varices, and 16 patients (48%) had no visible endoscopic bulge. Stent placement was successful in 31 patients (94%). Twenty-seven patients (82%) had complete resolution of a pseudocyst; 4 patients (12%) had partial resolution, with symptom relief. There were 2 major complications and 3 minor complications. Recurrence of a pseudocyst was observed in only 1 patient over a median follow-up of 46 weeks.

LIMITATIONS

No randomized treatment arm comparing this technique with conventional endoscopic drainage.

CONCLUSIONS

Single-step EUS-guided transmural drainage with large endoprostheses is a safe and effective therapy for patients with simple and complicated pancreatic pseudocysts.