Background: In this prospective case series, endoscopic management of pancreatic pseudocysts and Abscesses was investigated following an EUS-guided 1- step procedure for initial transmural access. Methods: Endoscopic ...Background: In this prospective case series, endoscopic management of pancreatic pseudocysts and Abscesses was investigated following an EUS-guided 1- step procedure for initial transmural access. Methods: Endoscopic drainage of pancreatic pseudocysts and Abscesses was performed in 35 patients (mean age, 51 years; range, 21- 81 years) by using interventional echoendoscopes (FG38UX and EG3830UT; Pentax-Hitachi, Lü bbecke, Germany). Interventions were performed by using a 1- step device consisting of a needle-wire suitable for cutting current, a 5.5F dilator, and an 8.5F plastic endoprosthesis (Giovannini Needle Wire Oasis, Cook Endoscopy,Winston-Salem, NC). Results: Endoscopic stent placement was successful in 33 of 35 patients (94% ), whereas repeated needle passages were unsuccessful in 2 cases (pancreatic pseudocystwall, 7 mm). No procedure-related complications, such as bleeding, perforation, or pneumoperitoneum, were observed. All subsequent complications, such as ineffective drainage (9% ), stent occlusion (12% ), or cyst infection (12% ), were managed endoscopically. Fourteen patients (43% ) demonstrated sustained clinical improvement and cyst resolutio upon placement of the initial 8.5F transmural drain. Ten patients (30% ) did not reveal a 50% reduction in cyst size on day 3, but cyst resolution was achieved by additional endoscopic cyst irrigation. Nine patients (27% ) with primary or secondary cyst infection underwent endoscopic balloon dilation and prolonged endoscopic drainage procedures to achieve cyst resolution. The overall resolution rate was 88% , with a recurrence rate of 12% , based on a mean follow-up period of 24 months. Conclusion: This 1- step EUS-guided technique with a needle-wire device provides safe transmural access and allows subsequent effective endoscopic management of pancreatic pseudocysts and Abscesses.展开更多
文摘Background: In this prospective case series, endoscopic management of pancreatic pseudocysts and Abscesses was investigated following an EUS-guided 1- step procedure for initial transmural access. Methods: Endoscopic drainage of pancreatic pseudocysts and Abscesses was performed in 35 patients (mean age, 51 years; range, 21- 81 years) by using interventional echoendoscopes (FG38UX and EG3830UT; Pentax-Hitachi, Lü bbecke, Germany). Interventions were performed by using a 1- step device consisting of a needle-wire suitable for cutting current, a 5.5F dilator, and an 8.5F plastic endoprosthesis (Giovannini Needle Wire Oasis, Cook Endoscopy,Winston-Salem, NC). Results: Endoscopic stent placement was successful in 33 of 35 patients (94% ), whereas repeated needle passages were unsuccessful in 2 cases (pancreatic pseudocystwall, 7 mm). No procedure-related complications, such as bleeding, perforation, or pneumoperitoneum, were observed. All subsequent complications, such as ineffective drainage (9% ), stent occlusion (12% ), or cyst infection (12% ), were managed endoscopically. Fourteen patients (43% ) demonstrated sustained clinical improvement and cyst resolutio upon placement of the initial 8.5F transmural drain. Ten patients (30% ) did not reveal a 50% reduction in cyst size on day 3, but cyst resolution was achieved by additional endoscopic cyst irrigation. Nine patients (27% ) with primary or secondary cyst infection underwent endoscopic balloon dilation and prolonged endoscopic drainage procedures to achieve cyst resolution. The overall resolution rate was 88% , with a recurrence rate of 12% , based on a mean follow-up period of 24 months. Conclusion: This 1- step EUS-guided technique with a needle-wire device provides safe transmural access and allows subsequent effective endoscopic management of pancreatic pseudocysts and Abscesses.
