Endoscopy 2011; 43 - A81
DOI: 10.1055/s-0031-1292152

Self-expandable Metal Stent without Balloon Dilation for Drainage of Pancreatic Fluid Collection Using a Front-view Forward-array Echoendoscope

F Marson 1, J Shah 1, F Weilert 1, K Binmoeller 1
  • 1Interventional Endoscopic Services, California Pacific Medical Center, San Francisco, USA

Possible complications of endoscopic transmural drainage of pancreatic fluid collections include perforation, bleeding, and secondary cyst infection. Insertion of a fully covered self-expandable metal stent (SEMS) without prior balloon dilation of the cystoenterostomy tract may significantly reduce these risks, as well as simplify and streamline the drainage procedure. Aim: To evaluate the technical success and outcomes of EUS-guided drainage of pancreatic fluid collections using SEMS without balloon dilation. Patients and Methods: Patients were identified in a prospectively collected database. All procedures were performed using a 3.7mm channel front-view forward-array echoendoscope (Olympus). The inner needle knife catheter component of the Cystotome (Cook Medical) was used to puncture the pancreatic fluid collection. Fluid was aspirated for analysis followed by injection of full-strength contrast to opacify the cyst. The tract was enlarged using the 10 Fr outer catheter component equipped with a diathermy ring. A fully covered 10mm X 40mm WallFlex stent was inserted to drain the cyst. SEMS were removed 7 days post implantation and, if indicated, further intervention including cyst debridement and plastic stent placement performed. Results: Between February 2009 and June 2010 thirty-four patients with pancreatic fluid collection were treated (20M:14F; mean age 53.3 years). The mean size of the fluid collection was 8.4cm +/-3.0cm. The mean procedure time was 28.82min. The procedure was technically successful in all patients with no procedure-related complication, including bleeding or perforation. SEMS were in-situ and patent in all patients at 7 days and removed without difficulty. Conclusion: Insertion of a covered SEMS without prior balloon dilation using a front-view forward-array echoendoscope appears to reduce procedural risks, as well as simplify and streamline the drainage procedure.