Initial evaluation of a novel prototype forward-viewing US endoscope in transmural drainage of pancreatic pseudocysts (with videos)

Abstract

Background: Transmural endoscopic drainage has become the treatment of first choice for uncomplicated pseudocysts. Drainage is mostly performed with presently available therapeutic oblique-viewing (45 degrees ) US endoscopes. Puncturing at an angle sometimes hampers successful completion of the procedure, because the force that is applied while introducing instruments through the working channel is not fully exerted at the tip of the accessory but instead drives the endoscope away from the gut wall. A prototype forward-viewing US endoscope was developed to overcome this difficulty.

Objective: Evaluation of an initial experience with a novel prototype forward-viewing US endoscope in endoscopic drainage of pancreatic pseudocysts.

Design: Retrospective, observational study.

Setting: Two tertiary-referral centers.

Patients: Seven patients were treated.

Interventions: Endoscopic drainage of pancreatic pseudocyst with a novel forward-viewing US endoscope.

Main outcome measurements: Successful endoscopic drainage.

Observations: In all cases drainage was successfully performed without complications. In 2 cases, the procedure was initially started with a conventional side-viewing EUS scope, but it proved impossible to puncture the pseudocyst. However, with the use of the forward-viewing EUS scope, both pseudocysts were successfully punctured.

Limitations: Small sample size.

Conclusions: Initial clinical experience with this novel prototype forward-view US endoscope for transmural drainage of pancreatic pseudocyst is favorable. It provides better control during puncturing of the cyst wall and creates a possibility to drain collections that are inaccessible with a conventional therapeutic side-viewing US endoscope.