Endosonography-guided transmural drainage of pancreatic pseudocysts using an exchange-free access device: initial clinic
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and Other Interventional Techniques
Endosonography-guided transmural drainage of pancreatic pseudocysts using an exchange-free access device: initial clinical experience Kenneth F. Binmoeller • Frank Weilert • Janak N. Shah • Yasser M. Bhat • Steve Kane
Received: 26 March 2012 / Accepted: 22 October 2012 / Published online: 9 January 2013 Ó Springer Science+Business Media New York 2013
Abstract Background Endosonography (EUS)-guided transmural pseudocyst drainage is a multistep procedure currently performed with different ‘‘off-the-shelf’’ accessories developed for other applications. Multiple device exchanges over-the-wire is time consuming and risks loss of wire access. This report describes the technical feasibility and outcomes for EUS-guided drainage of pancreatic fluid collections using a novel exchange-free device developed for translumenal therapy. Methods Between April and November 2010, 14 patients (9 men; mean age, 49.9 years) with pancreatic fluid collection (mean size, 102 mm) underwent 16 EUS-guided drainage procedures using the exchange-free access device at a single tertiary care center. The trocar of the exchangefree device was used to gain pseudocyst access. The dualballoon catheter then was advanced over the trocar, followed by inflation of the (first) anchor balloon. Cyst contents were sampled, and contrast was injected to define the pseudocyst anatomy. The first guidewire was inserted into the cyst cavity. The cystenterostomy tract was dilated to 10 mm with the (second) dilation balloon, followed by a second guidewire insertion. The exchange-free access device was removed, leaving the two guidewires in place for two double-pigtail stents. Results The procedure was technically successful for all the patients. No acute procedure-related complications
Electronic supplementary material The online version of this article (doi:10.1007/s00464-012-2682-9) contains supplementary material, which is available to authorized users. K. F. Binmoeller (&) F. Weilert J. N. Shah Y. M. Bhat S. Kane Paul May and Frank Stein Center for Interventional Endoscopy, California Pacific Medical Center, San Francisco, CA, USA e-mail: [email protected]
occurred. Late complications included a symptomatic leak in a patient who underwent drainage of a pancreatic uncinate pseudocyst from the second duodenum, a self-limited transfusion-dependent bleed after transbulbar drainage, and symptomatic pseudocyst infection. Conclusion Pseudocyst access, cystenterostomy tract dilation, and placement of two guidewires for dual stent drainage are technically feasible using an exchange-free access device. The device has the potential to standardize, simplify, and streamline EUS-guided pseudocyst drainage with a single instrument. Comparative studies with alternative tools and methods for pseudocyst drainage are warranted. Keywords Endoscopic ultrasonography Endosonography Pseudocyst drainage Exchange-free access device Cystenterostomy
Endoscopic ultrasound (EUS)-guided pseudocyst drainage currently is performed
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