Elsevier

Mayo Clinic Proceedings

Volume 76, Issue 8, August 2001, Pages 794-798
Mayo Clinic Proceedings

Original Article
Utility of Endoscopic Ultrasonography in Endoscopic Drainage of Pancreatic Pseudocysts in Selected Patients

https://doi.org/10.4065/76.8.794Get rights and content

Objectives

To determine the effect of endoscopic ultrasonography (EUS) on endoscopic drainage of pancreatic pseudocysts and to determine patency with fistula dilation and placement of multiple stents.

Patients and Methods

Between September 1995 and January 1999, 19 patients underwent endoscopic drainage of pancreatic pseudocysts, 17 of whom were assessed by EUS before drainage. Radial EUS scanning was used to detect an optimal site of apposition of pseudocyst and gut wall, free of intervening vessels. A fistula was created with a fistulatome, followed by balloon dilation of the fistula tract. Patency was maintained with multiple double pigtail stents. The primary goal of this retrospective study was to determine whether EUS affected the practice of endoscopic drainage of pancreatic pseudocysts.

Results

In 3 patients, drainage was not attempted based on EUS findings. In the other 13 patients (14 pseudo-cysts), creation of a fistula was successful on 13 occasions, and no immediate complications occurred. However, 1 patient subsequently developed sepsis that required surgery. All other patients were treated with balloon dilation, multiple stents, and antibiotics, with no septic complications. Of 14 pseudocysts (in 13 patients), 13 (93%) resolved.

Conclusions

Results of EUS may alter management of patients considered for endoscopic drainage of pancreatic pseudocysts. Endoscopic ultrasonography was useful for selecting an optimal and safe drainage site. The combination of balloon dilation, multiple stents, and antibiotics appears to resolve pancreatic pseudocysts without septic complications.

Section snippets

PATIENTS AND METHODS

Patients were identified from the endoscopic database at our institution. Patients were included in this study if their records were eligible for review under current state law (no patients were excluded on this basis). Clinical and procedural details were obtained from the hospital record and the endoscopic database. Patient follow-up was performed by using a scripted telephone interview and by reviewing the records of subsequent clinic visits. The study was approved by the Mayo Foundation

RESULTS

Endoscopic ultrasonography was performed before attempted drainage in 16 patients with 17 pseudocysts and in 1 patient with an organized pancreatic necrosis (11 men and 6 women with a median age of 45 years; range, 34–75 years). The cause of the pseudocysts and pancreatic necrosis was chronic pancreatitis in 9 patients (53%) and acute pancreatitis in 8 patients (47%). Pain was the presenting symptom in all subjects. Median pseudocyst size was 8 cm (range, 5–14 cm).

Three patients did not undergo

DISCUSSION

Throughout the past 10 years, endoscopic drainage of pseudocysts has gained acceptance as a relatively noninvasive and efficacious technique.1, 2, 3, 4, 5, 6, 7, 8 However, many issues regarding endoscopic drainage have yet to be resolved, including the best route of drainage (into the gut vs through the papilla) and the most efficient, most cost-effective, and safest way to establish drainage into the gastrointestinal tract.

Our data demonstrate that EUS is useful for assessing the

CONCLUSION

Our study showed the utility of EUS before attempted endoscopic drainage of pancreatic pseudocysts. Use of EUS allows reassessment of the lesion before drainage and selection of an optimal site for controlled puncture (apposition and absence of vascular structures). Balloon dilation of the drainage site appears to be a safe technique. In addition to balloon dilation, the placement of multiple stents and routine use of prophylactic antibiotics appear to ensure drainage with little risk of

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Presented in part at Digestive Disease Week, New Orleans, La, May 19, 1998.

Dr Norton is supported by the American Society for Gastrointestinal Endoscopy/Olympus Endoscopic Training Scholarship.

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Copyright © 2001 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.