|LETTER TO EDITOR
|Year : 2015 | Volume
| Issue : 3 | Page : 271-272
Endoscopic ultrasonography-guided drainage of a pancreatic pseudocyst one week after formation
Shupeng Wang, Wen Liu, Siyu Sun, Xiang Liu, Sheng Wang, Nan Ge, Guoxin Wang, Jintao Guo
Endoscopic Center, Shengjing Hospital of China Medical University, Liaoning, China
|Date of Web Publication||17-Aug-2015|
Dr. Siyu Sun
Endoscopic Center, Shengjing Hospital of China Medical University, Liaoning
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Wang S, Liu W, Sun S, Liu X, Wang S, Ge N, Wang G, Guo J. Endoscopic ultrasonography-guided drainage of a pancreatic pseudocyst one week after formation. Endosc Ultrasound 2015;4:271-2
|How to cite this URL:|
Wang S, Liu W, Sun S, Liu X, Wang S, Ge N, Wang G, Guo J. Endoscopic ultrasonography-guided drainage of a pancreatic pseudocyst one week after formation. Endosc Ultrasound [serial online] 2015 [cited 2020 Jan 21];4:271-2. Available from: http://www.eusjournal.com/text.asp?2015/4/3/271/163024
Endoscopic ultrasound (EUS) is the endoscopy combined with ultrasound to obtain images of the gastrointestinal (GI) tract and adjacent structures.  EUS-guided pancreatic pseudocyst (PPC) drainage has become increasingly popular due to its benefits, which include minimal invasiveness, lower cost, and excellent results. Conventional EUS-guided drainage requires an observation period of more than a month, we report a case of EUS-guided drainage about one week after PPC formation.
A 47 year-old man was admitted to our hospital following an abdominal crush injury. Increased abdominal pain and swelling appeared after 6 days of conservative treatment. An abdominal computed tomography (CT) revealed a PPC in the body of the pancreas measuring 9 cm in diameter [Figure 1], which constricted the intestinal tract. EUS [Figure 2] revealed that the cyst wall had a thickness of approximately 1 cm, and a good adhesion between the cyst wall and stomach wall; no relative motion when the patient took a deep breath. In order to relieve the gastrointestinal obstruction and intolerable abdominal distention, we performed EUS-guided PPC drainage on the 7 th day [Figure 3]. Strong adhesions were formed between the cyst and the gastric wall; furthermore, fluid leakage did not occur. Neither pancreatitis nor any other infectious process occurred. The amylase level of the drainage fluid was 44,220 U/L and the lipase level was 118,430 U/L. One day after drainage, the abdominal pain and swelling significantly decreased. Four days later, CT revealed that the PPC had decreased in size [Figure 4]. Five months later, the stent was removed. A recurrence did not occur during 12 months of follow-up.
|Figure 1. CT reveals rupture of the pancreatic body and a large PPC with gastric compression. CT: Computed tomography; PPC: Pancreatic pseudocyst|
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|Figure 2. EUS image of the PPC before drainage. EUS: Endoscopic ultrasound|
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|Figure 4. CT reveals significant reduction of the PPC following drainage|
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The formation of PPC as a complication of pancreatitis, operation, or trauma may lead to abdominal pain, gastric outlet obstruction, jaundice, pseudocyst infection, and even neighboring organ necrosis.  Therefore, medical intervention is necessary when conservative treatments fail. EUS-guided PPC drainage is safe, economical, and effective; it has become the first clinical choice instead of surgery. ,,, However, the appropriate timing for drainage is difficult to determine in the clinical setting.
Traditionally, a 6-week observation period is generally recommended prior to the drainage of a PPC, which is based on two points:
However, occasionally some PPCs will enlarge rapidly and cause painful compression of the surrounding structures, such as in our case. This situation requires immediate and effective intervention. When a 6-week observation of a PPC is not feasible, a preoperative diagnostic EUS is essential; it can measure the thickness of cyst wall and evaluate whether adhesions are present between the cyst and gastric wall. A successful emergency drainage can promptly alleviate pain.
- Spontaneous regression may occur; and
- The PPC wall requires time to thicken. ,
This case demonstrates that the cutoff time of 6 weeks should be reevaluated. In our opinion, the size of PPC ,, and the thickness of the cyst wall should take precedence over the 6-week observation period. This clinical observation has some limitations. One case cannot determine the necessity for modification of the traditional 6 week cutoff and the case lack of long-term follow-up. Thus, further studies are needed.
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[Figure 1], [Figure 2], [Figure 3]