Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos)

Varadarajulu, Shyam; Christein, John D.; Tamhane, Ashutosh; Drelichman, Ernesto R.; Wilcox, C. Mel

doi:10.1016/j.gie.2008.04.028

Cited by 401 publications

(263 citation statements)

References 21 publications

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“…Standard endoscopic treatment without EUS depends on luminal bulging [217][218][219][220][221][222]. EUS significantly improves the safety of endoscopic drainage by visualizing the cyst (it could drain cysts without bulging) and vascular structures [223][224][225]. Knowledge of the etiology of the pseudocyst, morphology of main pancreatic duct (presence of stricture) and its correlation with pseudocysts (communication or not) is also crucial in planning endoscopic therapy.…”

Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

See 1 more Smart Citation

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

166

112

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This paper gives practical guidelines for diagnosis and treatment of chronic pancreatitis. Statements have been elaborated by working teams of experts, by searching for and analysing the literature, and submitted to a consensus process by using a Delphi modified procedure. The statements report recommendations on clinical and nutritional approach, assessment of pancreatic function, treatment of exocrine pancreatic failure and of secondary diabetes, treatment of pain and prevention of painful relapses. Moreover, the role of endoscopy in approaching pancreatic pain, pancreatic stones, duct narrowing and dilation, and complications was considered. Recommendations for most appropriate use of various imaging techniques and of ultrasound endoscopy are reported. Finally, a group of recommendations are addressed to the surgical treatment, with definition of right indications, timing, most appropriate procedures and techniques in different clinical conditions and targets, and clinical and functional outcomes following surgery. © 2010 Editrice Gastroenterologica Italiana S.r.l

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Section: E3: Is Endoscopic Therapy Indicated In Chronic Pancreatitismentioning

confidence: 99%

“…Surgically, pseudocysts can be treated by anastomosis with a Roux-en-Y jejunal loop or with the stomach, or by lateral pancreatico-jejunostomy alone in case of dilated duct (>7 mm) [245]. When endoscopic treatment is preferred, endoscopic ultrasound-guided drainage seems safer than conventional endoscopic drainage [223].…”

Section: S2mentioning

confidence: 99%

Italian consensus guidelines for chronic pancreatitis

Frulloni

Falconi

Gabbrielli

et al. 2010

Digestive and Liver Disease

166

112

View full text Add to dashboard Cite

show abstract

“…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%

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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“…In this study, the technical success rate was significantly higher in EUS-guided assessment whereas the complication rate was comparable in both groups. In Varadarajulu's et al opinion [85], EUS should be considered as the first-line treatment modality for endoscopic drainage of pancreatic pseudocysts given its high technical success rate. In their study, comparing EUS and endoscopy guidance in pancreatic cyst transmural drainage, the clinical success and complications rates were comparable in both methods, but the technical success rate was significantly higher in the EUS-guided group.…”

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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Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos)

Cited by 401 publications

References 21 publications

Italian consensus guidelines for chronic pancreatitis

Italian consensus guidelines for chronic pancreatitis

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

Pancreatic cysts: etiology, diagnosis and management

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