Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial

Dh, Park; Ss, Lee; Sh, Moon; Sy, Choi; Sw, Jung; Dw, Seo; Sk, Lee; Mh, Kim

doi:10.1055/s-0029-1215133

Cited by 307 publications

(193 citation statements)

References 19 publications

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“…18 This technique showed higher technical success rate compared to conventional method in previous reports. 4,19 The present study investigated retrospectively the technical and clinical success, complication, and recurrence, in 47 patients undergoing single-step EUS-guided transmural drainage of pancreatic pseudocysts in a single center. The median follow-up time was 16.5 months.…”

Section: Discussionmentioning

confidence: 99%

“…3 Blind endoscopic drainage carries a risk of bleeding or perforation and is not preferred for nonbulging pseudocyst because avoiding major vessels and adjacent structures is difficult. 4 After the development of endoscopic ultrasound (EUS), beside accurate diagnosis, 5 two-step EUS-guided drainage has been tried for added safety, which is performed with a duodenoscope after marking an optimal site by EUS. However, this technique prolongs the procedure time and increases patient discomfort and the need for sedation.…”

Section: Introductionmentioning

confidence: 99%

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Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety

Ahn

Seo²,

Eum³

et al. 2010

Gut Liver

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Background/Aims: With the progress of product development, single-step endoscopic ultrasound (EUS)-guided transmural drainage can overcome some disadvantages of the blind or two-step procedures used in the treatment of pancreatic pseudocysts. We therefore evaluated the technical feasibility, efficacy, and safety of single-step EUS-guided transmural drainage of pancreatic pseudocysts. Methods: Endoscopic drainage of pancreatic pseudocysts was performed in 47 patients (median age, 46 years; range, 38 years to 59 years; 40 men) by using interventional echoendoscopes with a single-step device suitable for ballooning, bougination, and plastic-stent insertion. Results: Endoscopic stent placement was successful in 42 patients (89%; transgastric approach, 34/38; transduodenal approach, 8/9) and failed in 5 patients because of acute angulation (n=4) or small cyst (n=1). The volume of the pseudocyst was reduced by more than 90% or it disappeared completely in all of 41 patients (100%), based on a mean follow-up period of 17 months (range, 11 months to 20 months). The overall recurrence rate was 12% (5/41) after improvement by the procedure. Minor complications (one case of bleeding, three cases of pneumoperitoneum, and one case of peritonitis) occurred after the procedure in five patients (11%), but there were no major complications. Conclusions: Single-step EUS-guided transmural drainage can be used to treat pancreatic pseudocysts with acceptable feasibility, efficacy, and safety. (Gut Liver 2010;4:524-529)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety

Ahn

Seo²,

Eum³

et al. 2010

Gut Liver

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“…Our team [64] and others [72] have demonstrated that EUS-guided drainage and conventional transmural drainage techniques have fairly comparable rates of success and similar rates of complications if non bulging collection and patient at higher risk of bleeding are selectively drained using EGPD.…”

Section: Pancreatic Stonesmentioning

confidence: 91%

Endoscopic management of chronic pancreatitis

Oza

Kahaleh²

2013

WJGE

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Chronic pancreatitis (CP) is a common gastrointestinal illness, which affects the quality of life with substantial morbidity and mortality. The management includes medical, endoscopic and surgical approaches with the need for interaction between various specialties, calling for a concerted multidisciplinary approach. However, at the time of this publication, guidelines to establish care of these patients are lacking. This review provides the reader with a comprehensive overview of the studies summarizing the various treatment options available, including medical, surgical and endoscopic options. In addition, technological advances such as endoscopic retrograde cholangiopancreatogrophy, endoscopic shock wave lithotripsy and endoscopic ultrasound can now be offered with reasonable success for pancreatic decompression, stricture dilatation with stent placement, stone fragmentation, pseudocyst drainage, and other endoscopic interventions such as celiac plexus block for pain relief. We emphasize the endoscopic options in this review, and attempt to extract the most up to date information from the current literature. The treatment of CP and its complications are discussed extensively. Complications such as biliary strictures. pancreatic pseudocysts, and chronic pain are common issues that arise as long-term complications of CP. These often require endoscopic or surgical management and possibly a combination of approaches, however choosing amongst the various therapeutic and palliative modalities while weighing the risks and benefits, makes the management of CP challenging. Treatment goals should be not just to control symptoms but also to prevent disease progression. Our aim in this paper is to advocate and emphasize an evidence based approach for the management of CP and associated long term complications.

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“…Volmar et al [46] reported that for lesions <3 cm, the EUS-guided FNA had higher accuracy than US or CT. With CT or EUS guidance, samples of the cystic fluid and cyst walls can be taken by fine needle aspiration and brushing for cytology and measurement of tumour markers, viscosity, and amylase (that will be described in the further part of this paper) [17,28,[47][48][49][50][51][52]. Similar to transabdominal US, EUS also allows a therapeutic approach such as EUS-guided pancreatic pseudocyst drainage (that will be discussed in a chapter regarding management) [53][54][55][56][57][58][59][60][61].…”

Section: Endoscopic Ultrasnonography (Eus)mentioning

confidence: 99%

“…Endoscopic drainage may be performed under EUS and endoscopy guidance. Park et al [56] compared endoscopic ultrasound (EUS)-guided transmural drainage versus conventional transmural drainage by endoscopy. Authors concluded that both EUS-guided and conventional methods could be considered first-line methods of endoscopic transmural drainage of bulging pseudocysts whereas EUS-guided assess should be preferred for non-bulging pseudocysts.…”

Section: Percutaneous and Endoscopic Drainage Of Pancreatic Pseudocystsmentioning

confidence: 99%

Pancreatic cysts: etiology, diagnosis and management

Jabłońska

2014

Open Medicine

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AbstractPancreatic cysts involve a wide spectrum of pathologies from post-inflammatory cysts to malignant neoplasms. Pancreatic pseudocysts, serous cystadenomas, mucinous cystadenomas, intraductal papillary mucinous neoplasms (IPMNs) and solid pseudopapillary tumors occur most frequently. Differential diagnosis involves the following imaging investigations: transabdominal ultrasonography (TUS), contrast enhanced ultrasonography (CEUS) and endoscopic ultrasonography (EUS), computed tomography (CT), magnetic resonance (MR) and magnetic resonance cholangiopancretography (MRCP), endoscopic retrograde cholangiopancretography (ERCP). The cyst fluid cytology is performed in difficult differential diagnosis between pseudocysts and benign and potentially malignant or malignant tumors. Most frequently, viscosity, amylase, CEA and CA 19-9 levels are determined. Imaging findings should be correlated with cytology. The management depends on the cyst type and size. Small asymptomatic pseudocysts, serous cystadenomas and branchduct IPMNs should be carefully observed, whereas symptomatic large or uncertain serous cystadenomas and cystadenocarcinomas, mucinous cystadenomas and cystadenocarcinomas, main-duct IPMNs and large branch-duct IPMNs with malignant features, serous and mucinous cystadenocarcinomas, and solid pseudopapillary tumors require surgery. Pseudocysts are usually drained. Percutaneous / EUS-guided or surgical cyst drainage can be performed. Complicated and uncertain pseudocysts and cystic tumors need surgical resection. The type of surgery depends on cyst location and size and includes proximal, central, distal, total pancreatectomies and enucleation.

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Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial

Abstract: We found that EUD and CTD can both be considered first-line methods of endoscopic transmural drainage of bulging pseudocysts, whereas EUD should be preferred for nonbulging pseudocysts.

Cited by 307 publications

References 19 publications

Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety

Single-Step EUS-Guided Transmural Drainage of Pancreatic Pseudocysts: Analysis of Technical Feasibility, Efficacy, and Safety

Endoscopic management of chronic pancreatitis

Pancreatic cysts: etiology, diagnosis and management

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