[Endosonography controlled transgastric drainage of pancreatic pseudocysts]

Endoscopic drainage of a pancreatic pseudocyst is an alternative to surgical intervention. But transmural drainage carries the risk of bleeding or perforation. Effectiveness and complication rate of endoscopic ultrasound-guided drainage, to avoid these risks, was investigated.

Eleven patients (eight men, three women; mean age 55 years) with a pancreatic pseudocyst (nine with alcoholic and two with biliary pancreatitis) were studied prospectively between 1996 and 1998. In all of them transpapillary drainage of the cyst had not been technically possible. After an endoscopic ultrasound (EUS) examination, the gastric wall was incised with a fistulotome under EUS guidance. A guide-wire was then advanced through the fistulotome into the pseudocyst. A double pigtail catheter was implanted for drainage. The size of the pseudocyst was monitored sonographically at two-week intervals.

A cystogastrostomy was successfully established in ten of the twelve patients without serious complication. The pseudocyst was no longer demonstrated after a mean of 4.2 months (2 weeks to 6 months), while a small pseudocyst (1.6 cm [0.9-2.4 cm) remained in three patients. In two of the latter the size of the pseudocyst increased again after removal of the drainage catheter. Complete drainage by repeat cystogastrostomy succeeded in one of them, while a cystojejunostomy was established in the other.

Endoscopic ultrasound-guided transgastric drainage of a pancreatic pseudocyst is an effective treatment with few complications.