Combined percutaneous-endoscopic pancreatic pseudocyst drainage--a new technique

Surgical drainage has been the traditional approach to treating pancreatic pseudocysts. Percutaneous and endoscopic treatment of pancreatic pseudocyst were recently suggested as an alternative to surgery. In order to avoid the difficulties that can be observed in some patients in the percutaneous or endoscopic management of pancreatic pseudocysts we have used a combined procedure. We have treated by the "rendezvous" technique two patients suffering from pancreatic fistula complicating pancreatic pseudocysts. A percutaneous-endoscopic approach was used to place an internal stent between the pseudocyst and the duodenum. We have applied the same combined approach to the main pancreatic duct that is usual for bile duct obstruction without noticeable complications. Although application of this technique will be very limited, we advocate in the future the combined approach to treating pancreatic pseudocyst when there is a fistula between the fluid collection and pancreatic duct, and the downstream main pancreatic duct is obstructed, preventing use of the transpapillary approach.