Endoscopic ultrasound-guided pancreatic pseudocyst drainage (EUS-PPD) is a well-established
technique [1]
[2]
[3]. The procedure can be performed using a lumen-apposing metal stent (LAMS), allowing
effective drainage because of the large diameter of the stent compared with plastic
stents. However, a recent meta-analysis comparing EUS-PPD using plastic stents and
LAMS reported similar technical and clinical success rates [4]. Additionally, plastic stent deployment still plays an important role from the perspective
of cost-effectiveness in cases of pancreatic pseudocysts with fluid contents. However,
the procedure requires deployment of two plastic stents, two guidewire insertions,
and tract dilation after deployment of the first plastic stent. This leads to prolonged
procedure time and higher costs. To overcome these issues, a novel dilation device
(Meissa; Japan Lifeline, Tokyo, Japan) has been developed ([Fig. 1]) [5]. The tip of this device is 2.3 Fr, and its maximum diameter is 7.4 Fr. In addition,
a side hole is provided 2 cm from the tip. This enables contrast medium injection,
aspiration of infected cyst fluid, and additional 0.025-inch guidewire insertion to
be performed. Herein, we describe the technical procedure for EUS-PPD using this device.
Fig. 1 A novel dilation device (Meissa; Japan Lifeline, Tokyo, Japan).
A 55-year-old man was admitted to our hospital for the treatment of a pancreatic pseudocyst.
Since EUS imaging showed that the pancreatic pseudocyst mainly contained fluid, EUS-PPD
using a plastic stent was attempted. The pseudocyst was punctured using a 19G needle,
and a 0.025-inch guidewire was inserted into the cyst ([Fig. 2]). Next, a double-lumen dilator was smoothly inserted into the cyst. Then, an additional
0.025-inch guidewire was inserted into the cyst via the double-lumen dilator ([Fig. 3]), and a 7-Fr double-pigtail plastic stent was subsequently deployed ([Fig. 4]). Finally, insertion of an additional 7-Fr double-pigtail plastic stent was attempted.
Since insertion of the double-lumen dilator had resulted in adequate tract dilation,
this procedure was successfully performed without additional tract dilation or adverse
events ([Fig. 5], [Video 1]).
Fig. 2 The pseudocyst is punctured using a 19G needle, and a 0.025-inch guidewire is inserted
into the cyst.
Fig. 3 An additional 0.025-inch guidewire is inserted into the cyst via the double-lumen
dilator.
Fig. 4 A 7-Fr double-pigtail plastic stent is subsequently deployed.
Fig. 5 Insertion of an additional 7-Fr double-pigtail plastic stent is successfully performed
without additional tract dilation.
Endoscopic ultrasound-guided pancreatic pseudocyst drainage using a novel double-lumen
dilator.Video 1
In conclusion, the novel double-lumen dilator might serve a dual purpose during EUS-PPD,
namely, allowing double guidewire deployment and tract dilation.
Endoscopy_UCTN_Code_TTT_1AS_2AJ
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