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
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
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
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
