Only few severe complications after endoscopic ultrasound guided drainage of pancreatic pseudocysts

Pancreatic pseudocysts arise as a complication to acute or chronic pancreatitis. Transmural drainage under guidance of endoscopic ultrasound (EUS) is a minimally invasive approach. The results of a case series was retrospectively reviewed with a mean follow-up of 441 days.

Twenty-two consecutive patients (mean age 51 years, 13 men) who had undergone EUS-guided drainage of pancreatic pseudocysts were included between December 2005 and August 2010. The mean cyst size was 8.1 cm. One or two 10 Fr. double pigtail stents were inserted into the pseudocyst from either the stomach or the duodenum.

Insertion of a stent failed in three of 22 patients. Two cases were discontinued due to technical difficulties. One procedure was converted to a surgical cystogastrostomy. In 19 patients, a stent was successfully inserted. Three developed symptomatic recurrences due to stent malfunction. One developed a pseudocyst that mechanically obstructed the common bile duct. One developed a malignant cyst. One had a surgical cystogastrostomy for reasons unrelated to the stent insertion. For 13 patients (59%), a single endoscopic treatment resulted in relief of symptoms and resolution of the pseudocysts. However, one of these subsequently developed an asymptomatic pseudocyst.

EUS-guided endoscopy has only few severe complications and long-term results are acceptable. Nevertheless, insertion can be technically challenging and stent-related complications may cause recurrence.

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