• Users Online:66
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
LETTER TO EDITOR
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 271-272

Endoscopic ultrasonography-guided drainage of a pancreatic pseudocyst one week after formation


Endoscopic Center, Shengjing Hospital of China Medical University, Liaoning, China

Date of Web Publication17-Aug-2015

Correspondence Address:
Dr. Siyu Sun
Endoscopic Center, Shengjing Hospital of China Medical University, Liaoning
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.163024

Rights and Permissions

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 2019 Aug 25];4:271-2. Available from: http://www.eusjournal.com/text.asp?2015/4/3/271/163024

Dear Editor,

Endoscopic ultrasound (EUS) is the endoscopy combined with ultrasound to obtain images of the gastrointestinal (GI) tract and adjacent structures. [1] 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

Click here to view
Figure 2. EUS image of the PPC before drainage. EUS: Endoscopic ultrasound

Click here to view
Figure 4. CT reveals significant reduction of the PPC following drainage

Click here to view
Figure 3. Gastroscopy and EUS views during drainage

Click here to view


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. [2] 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. [3],[4],[5],[6] 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:

  1. Spontaneous regression may occur; and
  2. The PPC wall requires time to thicken. [5],[7]
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.

This case demonstrates that the cutoff time of 6 weeks should be reevaluated. In our opinion, the size of PPC [5],[8],[9] 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.

 
  References Top

1.
Ge N, Sun S. Endoscopic ultrasound: An all in one technique vibrates virtually around the whole internal medical field. J Transl Intern Med 2014;2:104-6.  Back to cited text no. 1
    
2.
Ertuğrul I, Yüksel I, Parlak E, et al. Gastric necrosis due to rapidly growing pancreatic pseudocyst. Am J Gastroenterol 2008; 103: 2949-51.  Back to cited text no. 2
    
3.
Varadarajulu S, Lopes TL, Wilcox CM, et al. EUS versus surgical pseudocyst-gastrostomy for management of pancreatic pseudopseudocysts. Gastrointest Endosc 2008;68:649-55.  Back to cited text no. 3
    
4.
Kahaleh M, Shami VM, Conaway MR, et al. Endoscopic ultrasound drainage of pancreatic pseudocyst: A prospective comparison with conventional endoscopic drainage. Endoscopy 2006;38:355-9.  Back to cited text no. 4
    
5.
Giovannini M. Endoscopic ultrasound-guided pancreatic pseudocyst drainage. Gastrointest Endosc Clin N Am 2005;15:179-88.  Back to cited text no. 5
    
6.
Varadarajulu S, Tamhane A, Blakely J. Graded dilation technique for EUS-guided drainage of peripancreatic fluid collections: An assessment of outcomes and complications and technical proficiency (with video). Gastrointest Endosc 2008;68:656-66.  Back to cited text no. 6
    
7.
Brugge WR. Approaches to the drainage of pancreatic pseudocysts. Curr Opin Gastroenterol 2004;20:488-92.  Back to cited text no. 7
    
8.
Roeder BE, Pfau PR. Endoscopic pancreatic pseudocyst drainage. Tech Gastrointest Endosc 2005;7:211-8.  Back to cited text no. 8
    
9.
Yasuda I, Iwata K, Mukai T, et al. EUS-guided pancreatic pseudocyst drainage. Dig Endosc 2009;21:S82-6.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Figure 4]


This article has been cited by
1 The role of endoscopic ultrasound in children with Pancreatobiliary and gastrointestinal disorders: a single center series and review of the literature
Alessandro Fugazza,Barbara Bizzarri,Federica Gaiani,Marco Manfredi,Alessia Ghiselli,Pellegrino Crafa,Maria Clotilde Carra,Nicola de’Angelis,Gian Luigi de’Angelis
BMC Pediatrics. 2017; 17(1)
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed665    
    Printed9    
    Emailed0    
    PDF Downloaded204    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]