Endoscopic Transgastric Drainage of Pancreatic Pseudocyst With the Use of Nd:YAG Laser

Abstract

Pancreatic pseudocysts have been successfully managed with endoscopic drainage recently. This report describes a case of endoscopic transgastric drainage using endoscopic ultrasonography (EUS) and an Nd:YAG laser. EUS was used to detect an optimal puncture site of the pseudocyst and to reduce the risk of bleeding and perforation. An Nd:YAG laser was used to minimize the risk of bleeding and to penetrate the thick wall of the pseudocyst. After transgastric cystgastrostomy was performed, an internal stent was placed between the pseudocyst and the stomach. There were no complications associated with endoscopic interventions. Complete resolution of the pseudocyst was observed. Endoscopic transgastric drainage of pancreatic pseudocysts is a recommended approach for selected patients with pancreatic pseudocysts that are uncomplicated and are located adjacent to the stomach. Safe and effective drainage can be achieved without hemorrhage and perforation with the use of EUS, an Nd:YAG laser, and a stent. Furthermore, the Nd:YAG laser facilitated passage through a markedly indurated pseudocyst wall and it seemed to be an effective instrument, especially for pseudocysts with a thick wall.

Transgastric pancreatography and EUS-guided drainage of the pancreatic duct

“…Recently, Nd.YAG laser with EUS-guided drainage has been used for the drainage of pancreatic pseudocysts. 9 An interesting further approach is laparoscopic pancreatic cystgastrostomy, which combines the surgical approach ("intragastric surgical technique") with the less invasive approach of laparoscopy; in particular, in large retrogastric pancreatic pseudocysts. 10,11 This combined approach allows concomitant debridement of necrotic tissue, if necessary (an extra advantage).…”

Endoscopic cystogastrostomy

“…7 Many of these complications can be minimized with the use of endoscopic ultrasonography and ND:YAG laser. 10 In children internal drainage can be carried out safely earlier than in adults. 4,8 We did the endoscopic drainage not only at two weeks only, but also the earliest of all the reported pediatric cases.…”