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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
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2303-9027.163024

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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 Aug 3];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

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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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Figure 3. Gastroscopy and EUS views during 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. [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

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
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
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
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
Giovannini M. Endoscopic ultrasound-guided pancreatic pseudocyst drainage. Gastrointest Endosc Clin N Am 2005;15:179-88.  Back to cited text no. 5
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
Brugge WR. Approaches to the drainage of pancreatic pseudocysts. Curr Opin Gastroenterol 2004;20:488-92.  Back to cited text no. 7
Roeder BE, Pfau PR. Endoscopic pancreatic pseudocyst drainage. Tech Gastrointest Endosc 2005;7:211-8.  Back to cited text no. 8
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


  [Figure 1], [Figure 2], [Figure 3]

  [Figure 4]

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