Endoscopic cyst-gastrostomy for pancreatic pseudocysts: refining the indications

Abstract

Background: Pseudocysts are a common consequence of acute pancreatitis and require intervention if symptomatic. Endoscopic management is emerging as a safe and effective alternative to surgery, although its use is not yet widespread.

Methods: We describe our experience of 10 consecutive unselected patients who underwent endoscopic ultrasound-guided cyst-gastrostomy and stent insertion at a tertiary referral centre. Technical aspects of the procedure are detailed with accompanying photographs.

Results: Six patients made an uneventful recovery. Four patients developed complications, of which one was successfully salvaged by endoscopy and three required surgery.

Conclusion: We discuss technical and patient factors which may have contributed to these complications in the context of current literature, and in particular, found that the presence of necrosis was associated with higher morbidity, both in our series and in others. In our experience, endoscopic ultrasound-guided cyst-gastrostomy is best employed in simple, mature pseudocysts without necrotic debris, and we recommend this procedure only after a detailed assessment of the pseudocyst in a specialist hepatobiliary unit.

Keywords: drainage; endoscopic ultrasonography; endoscopy; gastrointestinal; pancreatic pseudocyst; pancreatitis.