Endoscopy 2005; 37(3): 231-235
DOI: 10.1055/s-2005-860997
Short Communication
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic Ultrasound-Guided Drainage of Pancreatic Pseudocysts Complicated by Portal Hypertension or by Intervening Vessels

P.  V.  J.  Sriram1 , A.  J.  Kaffes1 , G.  V.  Rao2 , D.  N.  Reddy1
  • 1Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
  • 2Gastointestinal Surgery, Asian Institute of Gastroenterology, Hyderabad, India
Further Information

Publication History

Submitted 12 August 2003

Accepted after Revision 6 September 2004

Publication Date:
24 February 2005 (online)

Background and Study Aims: Portal hypertension often coexists with pancreatic pseudocysts and is potentially dangerous if a collateral vessel is in the vicinity of the needle puncture pathway. Hitherto, there have been no reports of pseudocyst drainage in this setting.
Patients and Methods: Patients who underwent endoscopic ultrasound (EUS)-guided pancreatic pseudocyst drainage complicated by intervening vessels were assessed for success and outcomes. An Olympus mechanical linear-array video echo endoscope GF-UM 140D was used for the drainage procedure in all patients. Either a ”hot” diathermy technique was employed or a ”cold” technique using direct aspiration with a 19-G needle, followed by deployment of a nasocystic catheter.
Results: Eight patients with a symptomatic pseudocyst and intervening vessels underwent drainage that was guided (n = 6) or assisted (n = 2) by EUS. All were found to have successful resolution of the cyst at follow-up 6 weeks later, while segmental portal hypertension had disappeared in one patient. There were no major complications. One patient had transient hemorrhagic drainage that resolved by itself.
Conclusions: Pseudocysts complicated by portal hypertension or by intervening vessels can be safely drained under EUS guidance, even in the absence of color Doppler imaging.

References

  • 1 Usatoff V, Brancatisano R, Williamson R C. Operative treatment of pseudocysts in patients with chronic pancreatitis.  Br J Surg. 2000;  87 1494-1499
  • 2 van Sonnenberg E, Wittich G R, Casola G. et al . Complicated pancreatic inflammatory disease: diagnostic and therapeutic role of interventional radiology.  Radiology. 1985;  155 335-340
  • 3 Smits M E, Rauws E A, Tytgat G N, Huibregtse K. The efficacy of endoscopic treatment of pancreatic pseudocysts.  Gastrointest Endosc. 1995;  42 202-207
  • 4 Catalano M F, Geenen J E, Schmalz M J. et al . Treatment of pancreatic pseudocysts with ductal communication by transpapillary pancreatic duct endoprosthesis.  Gastrointest Endosc. 1995;  42 214-218
  • 5 Giovannini M, Binmoeller K, Seifert H. Endoscopic ultrasound-guided cystgastrostomy.  Endoscopy. 2003;  35 239-245
  • 6 Fockens P, Johnson T G, van Dullemen H M. et al . Endosonographic imaging of pancreatic pseudocysts before endoscopic transmural drainage.  Gastrointest Endosc. 1997;  46 412-416
  • 7 Norton I D, Clain J E, Wiersema M J. et al . Utility of endoscopic ultrasonography in endoscopic drainage of pancreatic pseudocysts in selected patients.  Mayo Clin Proc. 2001;  76 794-798
  • 8 Vosoghi M, Sial S, Garrett B. et al . EUS-guided pancreatic pseudocyst drainage: review and experience at Harbor-UCLA medical center.  Med Gen Med. 2002;  4 2
  • 9 Breslin N, Wallace M B. Diagnosis and fine needle aspiration of pancreatic pseudocysts: the role of endoscopic ultrasound.  Gastrointest Endosc Clin N Am. 2002;  12 781-790
  • 10 Fockens P. EUS in drainage of pancreatic pseudocysts.  Gastrointest Endosc. 2002;  56 S93-S97
  • 11 Giovannini M, Bernardini D, Seitz J F. Cystgastrostomy entirely performed under endosonography guidance for pancreatic pseudocysts: results in six patients.  Gastrointest Endosc. 1998;  48 200-203
  • 12 Raju G S, Olayee M, Weston A. et al . Pancreatic pseudocysts in a patient with cirrhotic ascites and portal hypertension: effective endoscopic drainage with Seldinger technique [letter].  Gastrointest Endosc. 1999;  50 455-456
  • 13 Chak A. Endosonographic-guided therapy for pancreatic pseudocysts.  Gastrointest Endosc. 2000;  52 (6 Suppl) S23-S27
  • 14 Pfaffenbach B, Langer M, Stabenow-Lohbauer U, Lux G. Endosonography controlled transgastric drainage of pancreatic pseudocysts [in German].  Dtsch Med Wochenschr. 1998;  123 1439-1442
  • 15 Giovannini M, Pesenti C, Rolland A L. et al . Endoscopic ultrasound-guided drainage of pancreatic pseudocysts or pancreatic abscesses using a therapeutic echo endoscope.  Endoscopy. 2001;  33 473-477

P. V. J. Sriram, M. D., D. M.

Asian Institute of Gastroenterology

6-3-652 Somajiguda · 500-082 Hyderabad · India

Fax: + 91-40-23324255

Email: pvjsriram2002@yahoo.com