Single-step EUS-guided Transmural Drainage of Simple and Complicated Pancreatic Pseudocysts

Background: Single-step EUS-guided transmural drainage of pseudocysts has been reported, but there are no published prospective studies on clinical outcomes.

Objective: To assess the safety and the efficacy of single-step EUS-guided placement of large endoprostheses to treat simple and complicated pseudocysts.

Design: Prospective cohort study.

Setting: Single tertiary referral center.

Patients: Consecutive patients referred for management of symptomatic chronic pancreatic pseudocysts >4 cm in size.

Interventions: Single-step EUS-guided transmural pseudocyst drainage performed with a linear-array echoendoscope for placement of 10F stents in adults and 7F stents in children.

Main Outcome Measures: Complete or partial (>50% reduction) resolution of pseudocyst on follow-up imaging, recurrence, clinical response, and procedure-related complications. Recurrence was defined as the reappearance of a pancreatic pseudocyst in the same location.

Results: There were 33 patients, with a mean age of 43 years. Median pseudocyst size was 8.5 cm (range, 4-20 cm). Fourteen patients (42%) had infected pseudocysts, 8 patients (24%) had gastric varices, and 16 patients (48%) had no visible endoscopic bulge. Stent placement was successful in 31 patients (94%). Twenty-seven patients (82%) had complete resolution of a pseudocyst; 4 patients (12%) had partial resolution, with symptom relief. There were 2 major complications and 3 minor complications. Recurrence of a pseudocyst was observed in only 1 patient over a median follow-up of 46 weeks.

Limitations: No randomized treatment arm comparing this technique with conventional endoscopic drainage.

Conclusions: Single-step EUS-guided transmural drainage with large endoprostheses is a safe and effective therapy for patients with simple and complicated pancreatic pseudocysts.