Technical and Clinical Outcomes of Using a Single Wide-Caliber Double-Pigtail Stent for Endoscopic Ultrasound-Guided Pancreatic Pseudocyst Drainage: A Multicenter Prospective Study

Overview

Journal GE Port J Gastroenterol

Specialty Gastroenterology

Date 2024 Mar 13

PMID 38476158

Authors

Elsayed Ghoneem

Hussein Okasha

Mohamed Hammouda

Mohamed Fathi Gouda

Reham Soliman

Gamal Shiha

Khaled Ragab

Ramy Hassan Agwa

Affiliations

Soon will be listed here.

Abstract

Introduction: Endoscopic ultrasound (EUS)-guided pancreatic cysto-gastrostomy/duodenostomy is the current accepted practice for management of symptomatic pancreatic pseudocysts with insertion of two or more double-pigtail (DP) stents. There is no much work on the efficacy of using a single wide-caliber DP stent, aiming to decrease the time, complications, and accessories used in the procedure.

Aim Of The Work: The aim of this study was to assess technical and clinical outcomes of using a single wide-caliber DP stent in EUSguided pancreatic pseudocyst drainage.

Methodology: This multicenter prospective study included 57 patients, from which the 35 patients with symptomatic pancreatic pseudocysts enrolled. Patients with cysts with multiple septations (7 cases) or cyst with >30% necrosis (8 cases) of the cyst content and patients with generalized ascites (4 cases) or patients with major comorbidities (3 cases) were excluded. Patients were followed up within 1 month and 6 months after stent placement to assess complete resolution or a decrease in the sizes of cysts with clinical symptomatic improvement.

Results: From 57 patients, 35 patients (19 females/16 males, median age 40 years) with a symptomatic pancreatic pseudocyst were referred for EUS-guided drainage. All used stents were 10 Fr DP plastic stents. The median duration of the whole procedure was 16 min. Technical success was achieved in all cases. Clinical success was encountered in 32 patients (91.4%) without re-accumulation on follow-up. Minor adverse events were encountered in 3 patients (8.6%) including post-procedure abdominal pain (1 case) and fever (2 cases).

Conclusion: We suggest that using a wide-caliber single-pigtail stent for EUS-guided cystogastrostomy is safe and effective with short procedure time, with reduced risks from the insertion of another stent(s).

References

Banks P, Bollen T, Dervenis C, Gooszen H, Johnson C, Sarr M . Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2012; 62(1):102-11. DOI: 10.1136/gutjnl-2012-302779. View

ELLIOTT D . Pancreatic pseudocysts. Surg Clin North Am. 1975; 55(2):339-62. DOI: 10.1016/s0039-6109(16)40585-2. View

Pereira F, Caldeira A, Leite S, Marques S, Moreira T, Moutinho-Ribeiro P . GRUPUGE Perspective: Endoscopic Ultrasound-Guided Drainage of Peripancreatic Collections. GE Port J Gastroenterol. 2021; 28(1):39-51. PMC: 7841806. DOI: 10.1159/000509193. View

Kim K, Kim T . Acute pancreatic pseudocyst: incidence, risk factors, and clinical outcomes. Pancreas. 2012; 41(4):577-81. DOI: 10.1097/MPA.0b013e3182374def. View

Giovannini M . Endoscopic ultrasound-guided pancreatic pseudocyst drainage. Gastrointest Endosc Clin N Am. 2004; 15(1):179-88, xi. DOI: 10.1016/j.giec.2004.07.007. View

Baillie J . Pancreatic pseudocysts (Part I). Gastrointest Endosc. 2004; 59(7):873-9. DOI: 10.1016/s0016-5107(04)00354-2. View

Bang J, Hawes R, Bartolucci A, Varadarajulu S . Efficacy of metal and plastic stents for transmural drainage of pancreatic fluid collections: a systematic review. Dig Endosc. 2014; 27(4):486-498. DOI: 10.1111/den.12418. View

Barthet M, Bugallo M, Moreira L, Bastid C, Sastre B, Sahel J . Management of cysts and pseudocysts complicating chronic pancreatitis. A retrospective study of 143 patients. Gastroenterol Clin Biol. 1993; 17(4):270-6. View

Shahid H . Endoscopic management of pancreatic fluid collections. Transl Gastroenterol Hepatol. 2019; 4:15. PMC: 6421163. DOI: 10.21037/tgh.2019.01.09. View

10.

Chatila A, Bilal M, Guturu P . Evaluation and management of acute pancreatitis. World J Clin Cases. 2019; 7(9):1006-1020. PMC: 6511926. DOI: 10.12998/wjcc.v7.i9.1006. View

11.

Brun A, Agarwal N, Pitchumoni C . Fluid collections in and around the pancreas in acute pancreatitis. J Clin Gastroenterol. 2011; 45(7):614-25. DOI: 10.1097/MCG.0b013e318213ef3e. View

12.

Yip H, Teoh A . Endoscopic Management of Peri-Pancreatic Fluid Collections. Gut Liver. 2017; 11(5):604-611. PMC: 5593321. DOI: 10.5009/gnl16178. View

13.

Saftoiu A, Vilmann A, Vilmann P . Endoscopic ultrasound-guided drainage of pancreatic pseudocysts. Endosc Ultrasound. 2015; 4(4):319-23. PMC: 4672590. DOI: 10.4103/2303-9027.170424. View

14.

Kitamura K, Yamamiya A, Ishii Y, Nomoto T, Honma T, Yoshida H . Electrocautery vs non-electrocautery dilation catheters in endoscopic ultrasonography-guided pancreatic fluid collection drainage. World J Gastrointest Endosc. 2016; 8(13):458-65. PMC: 4937161. DOI: 10.4253/wjge.v8.i13.458. View

15.

Fockens P . EUS in drainage of pancreatic pseudocysts. Gastrointest Endosc. 2002; 56(4 Suppl):S93-7. DOI: 10.1016/s0016-5107(02)70095-3. View

16.

Lin H, Zhan X, Sun S, Yang X, Jin Z, Zou D . Stent selection for endoscopic ultrasound-guided drainage of pancreatic fluid collections: a multicenter study in china. Gastroenterol Res Pract. 2014; 2014:193562. PMC: 4074944. DOI: 10.1155/2014/193562. View

17.

Yusuf T, Baron T . Endoscopic transmural drainage of pancreatic pseudocysts: results of a national and an international survey of ASGE members. Gastrointest Endosc. 2006; 63(2):223-7. DOI: 10.1016/j.gie.2005.09.034. View

18.

Ramsey M, Conwell D, Hart P . Complications of Chronic Pancreatitis. Dig Dis Sci. 2017; 62(7):1745-1750. PMC: 5667546. DOI: 10.1007/s10620-017-4518-x. View

19.

Bang J, Varadarajulu S . Endoscopic ultrasound-guided management of pancreatic pseudocysts and walled-off necrosis. Clin Endosc. 2014; 47(5):429-31. PMC: 4198560. DOI: 10.5946/ce.2014.47.5.429. View

20.

Bang J, Wilcox C, Trevino J, Ramesh J, Hasan M, Hawes R . Relationship between stent characteristics and treatment outcomes in endoscopic transmural drainage of uncomplicated pancreatic pseudocysts. Surg Endosc. 2014; 28(10):2877-83. DOI: 10.1007/s00464-014-3541-7. View