The Soehendra stent retriever is reported to be useful for dilating a stenosed pancreatic
or biliary duct [1]
[2]
[3]
[4]. We have also used it to drain a pancreatic pseudocyst under endoscopic ultrasound
(EUS) guidance.
Endoscopic cystogastrostomy with EUS guidance was carried out in three patients (two
men, one woman; aged 56, 76 and 45 years, respectively) with pancreatic pseudocysts
which developed during chronic pancreatitis. The etiology of the pancreatitis was
alcoholic in all three patients, and the cysts were located in the body or tail of
the pancreas. The mean diameter of the cysts was 5.9 cm (range 5.6 - 6.2 cm), and
the mean distance between the gastric wall and the cyst wall measured on EUS was 12
mm (range 9 - 14 mm). A 19-gauge puncture needle (Echo-Tip, Wilson-Cook Medical, Inc.,
Winston-Salem, North Carolina, USA) was successfully inserted into the cysts, but
it was not possible to introduce a 7-Fr plastic dilator catheter to dilate the puncture
hole in any of the patients. In two patients, an attempt was made to insert a needle-knife
electrocautery, but this failed. A Soehendra stent retriever (Wilson-Cook Medical,
Inc.) [5] was then used to dilate the puncture hole. The stent retriever was advanced with
the aid of the guide wire and torqued clockwise to allow the threads at the end of
the device to engage and sufficiently dilate the hole (Figures [1], [2]). After dilation of the hole, the dilator catheter and the pigtail stent were easily
introduced into the cyst in all of the patients. The cysts disappeared, and no recurrences
were observed. Minor bleeding was observed in all of the patients. The gastric mucosa
became wound round the stent retriever in two patients, but this complication was
not serious in either case.
Figure 1 A lateral spot radiograph taken during the procedure. The Soehendra stent retriever
is being advanced along the guide wire.
Figure 2 Endoscopic view of the Soehendra stent retriever penetrating through the gastric wall
into the cyst.
In endoscopic cystogastrostomy treatment for a pancreatic pseudocyst, use of a stent
retriever can be advantageous when the wall is hard and the procedure is difficult
with standard dilation techniques.
Endoscopy_UCTN_Code_TTT_1AS_2AD
