Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety
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Background/Aims: With the progress of product development,single-step endoscopic ultrasound (EUS)-guided transmural drainage can overcome some disadvantages of the blind or two-step procedures used in the treatment of pancreatic pseudocysts. We therefore evaluated the technical feasibility, efficacy, and safety of single-step EUS-guided transmural drainage of pancreatic pseudocysts. Methods: Endoscopic drainage of pancreatic pseudocysts was performed in 47patients (median age, 46 years; range, 38 years to 59 years; 40 men) by using interventional echoendoscopes with a single-step device suitable for ballooning,bougination, and plastic-stent insertion. Results:Endoscopic stent placement was successful in 42 patients (89%; transgastric approach, 34/38; transduodenal approach, 8/9) and failed in 5 patients because of acute angulation (n=4) or small cyst (n=1). The volume of the pseudocyst was reduced by more than 90% or it disappeared completely in all of 41patients (100%), based on a mean follow-up period of 17 months (range, 11 months to 20 months). The overall recurrence rate was 12% (5/41) after improvement by the procedure. Minor complications (one case of bleeding, three cases of pneumoperitoneum, and one case of peritonitis) occurred after the procedure in five patients (11%), but there were no major complications. Conclusions: Single-step EUS-guided transmural drainage can be used to treat pancreatic pseudocysts with acceptable feasibility, efficacy, and safety.
Abstract
Background/Aims: With the progress of product development,single-step endoscopic ultrasound (EUS)-guided transmural drainage can overcome some disadvantages of the blind or two-step procedures used in the treatment of pancreatic pseudocysts. We therefore evaluated the technical feasibility, efficacy, and safety of single-step EUS-guided transmural drainage of pancreatic pseudocysts. Methods: Endoscopic drainage of pancreatic pseudocysts was performed in 47patients (median age, 46 years; range, 38 years to 59 years; 40 men) by using interventional echoendoscopes with a single-step device suitable for ballooning,bougination, and plastic-stent insertion. Results:Endoscopic stent placement was successful in 42 patients (89%; transgastric approach, 34/38; transduodenal approach, 8/9) and failed in 5 patients because of acute angulation (n=4) or small cyst (n=1). The volume of the pseudocyst was reduced by more than 90% or it disappeared completely in all of 41patients (100%), based on a mean follow-up period of 17 months (range, 11 months to 20 months). The overall recurrence rate was 12% (5/41) after improvement by the procedure. Minor complications (one case of bleeding, three cases of pneumoperitoneum, and one case of peritonitis) occurred after the procedure in five patients (11%), but there were no major complications. Conclusions: Single-step EUS-guided transmural drainage can be used to treat pancreatic pseudocysts with acceptable feasibility, efficacy, and safety.
참고문헌 (22)
- Bradley EL 3rd, "A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, 1992", Arch Surg, 128, pp.586~590 (1993)
- Vosoghi M, "EUS-guided pancreatic pseudocyst drainage: review and experience at Harbor-UCLA Medical Center", MedGenMed, 4, pp.2~ (2002)
- vanSonnenberg E, "Percutaneous drainage of infected and noninfected pancreatic pseudocysts: experience in 101 cases", Radiology, 170, pp.757~761 (1989)
- Park DH, "Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial", Endoscopy, 41, pp.842~848 (2009)
- Song MH, "EUS in the evaluation of pancreatic cystic lesions", Gastrointest Endosc, 57, pp.891~896 (2003)
- Kitano M, "Present status and future perspective of EUS-guided drainage", Dig Endosc, 21(Suppl 1), pp.S66~S70 (2009)
- Antillon MR, "Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts", Gastrointest Endosc, 63, pp.797~803 (2006)
- Kruger M, "Endoscopic management of pancreatic pseudocysts or abscesses after an EUS-guided 1-step procedure for initial access", Gastrointest Endosc, 63, pp.409~416 (2006)
- Lopes CV, "Endoscopic-ultrasound-guided endoscopic transmural drainage of pancreatic pseudocysts and abscesses", Scand J Gastroenterol, 42, pp.524~529 (2007)
- Ardengh JC, "Single-step EUS-guided endoscopic treatment for sterile pancreatic collections: a single-center experience", Dig Dis, 26, pp.370~376 (2008)
- Song TJ, "Yield of EUS-guided FNA on the diagnosis of pancreatic", peripancreatic tuberculosis, 2009, pp.69, 484~491
- Chang Yun Hwang, "Endoscopic Ultrasound Guided Fine Needle Aspiration Biopsy in Diagnosis of Pancreatic and Peripancreatic Lesions: A Single Center Experience in Korea", Gut and Liver, 3(2), pp.116~121 (2009), 거트앤리버 발행위원회
- Lee SS, "EUS-guided transmural cholecystostomy as rescue management for acute cholecystitis in elderly or high-risk patients: a prospective feasibility study", Gastrointest Endosc, 66, pp.1008~1012 (2007)
- Oh HC, "New treatment for cystic tumors of the pancreas: EUS-guided ethanol lavage with paclitaxel injection", Gastrointest Endosc, 67, pp.636~642 (2008)
- Park do H, "EUS-guided biliary drainage with one-step placement of a fully covered metal stent for malignant biliary obstruction: a prospective feasibility study", Am J Gastroenterol, 104, pp.2168~2174 (2009)
- Hae Jung Song, "Endoscopic Ultrasonograpic Findings of Benign Mediastinal and Abdominal Lymphadenopathy Confirmed by EUS-guided Fine Needle Aspiration", Gut and Liver, 1(1), pp.68~73 (2007), 거트앤리버 발행위원회
- Vilmann P, "One-step endosonography-guided drainage of a pancreatic pseudocyst: a new technique of stent delivery through the echo endoscope", Endoscopy, 30, pp.730~733 (1998)
- Giovannini M, "Cystogastrotomy entirely performed under endosonography guidance for pancreatic pseudocyst: results in six patients", Gastrointest Endosc, 48, pp.200~203 (1998)
- Varadarajulu S, "Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos)", Gastrointest Endosc, 68, pp.1102~1111 (2008)
- Cahen D, "Endoscopic drainage of pancreatic pseudocysts: long-term outcome and procedural factors associated with safe and successful treatment", Endoscopy, 37, pp.977~983 (2005)
- Norton ID, "Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients", Mayo Clin Proc, 76, pp.794~798 (2001)
- Soliani P, "The size of pancreatic pseudocyst does not influence the outcome of invasive treatments", Dig Liver Dis, 36, pp.135~140 (2004)