Skip to main content
SpringerLink
Log in

Endosonography-guided transmural drainage of pancreatic pseudocysts using an exchange-free access device: initial clinical experience

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Endosonography (EUS)-guided transmural pseudocyst drainage is a multistep procedure currently performed with different “off-the-shelf” accessories developed for other applications. Multiple device exchanges over-the-wire is time consuming and risks loss of wire access. This report describes the technical feasibility and outcomes for EUS-guided drainage of pancreatic fluid collections using a novel exchange-free device developed for translumenal therapy.

Methods

Between April and November 2010, 14 patients (9 men; mean age, 49.9 years) with pancreatic fluid collection (mean size, 102 mm) underwent 16 EUS-guided drainage procedures using the exchange-free access device at a single tertiary care center. The trocar of the exchange-free device was used to gain pseudocyst access. The dual-balloon catheter then was advanced over the trocar, followed by inflation of the (first) anchor balloon. Cyst contents were sampled, and contrast was injected to define the pseudocyst anatomy. The first guidewire was inserted into the cyst cavity. The cystenterostomy tract was dilated to 10 mm with the (second) dilation balloon, followed by a second guidewire insertion. The exchange-free access device was removed, leaving the two guidewires in place for two double-pigtail stents.

Results

The procedure was technically successful for all the patients. No acute procedure-related complications occurred. Late complications included a symptomatic leak in a patient who underwent drainage of a pancreatic uncinate pseudocyst from the second duodenum, a self-limited transfusion-dependent bleed after transbulbar drainage, and symptomatic pseudocyst infection.

Conclusion

Pseudocyst access, cystenterostomy tract dilation, and placement of two guidewires for dual stent drainage are technically feasible using an exchange-free access device. The device has the potential to standardize, simplify, and streamline EUS-guided pseudocyst drainage with a single instrument. Comparative studies with alternative tools and methods for pseudocyst drainage are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Arvanitakis M, Delhaye M, Bali MA, Matos C, De Maertelaer V, Le Moine O, Deviere J (2007) Pancreatic-fluid collections: a randomized controlled trial regarding stent removal after endoscopic transmural drainage. Gastrointest Endosc 65:609–619

    Article  PubMed  Google Scholar 

  2. Seewald S, Thonke F, Ang TL, Omar S, Seitz U, Groth S, Zhong Y, Yekebas E, Izbicki J, Soehendra N (2006) One-step, simultaneous double-wire technique facilitates pancreatic pseudocyst and abscess drainage (with videos). Gastrointest Endosc 64:805–808

    Article  PubMed  Google Scholar 

  3. Reddy DN, Gupta R, Lakhtakia S, Jalal PK, Rao GV (2008) Use of a novel transluminal balloon accessotome in transmural drainage of pancreatic pseudocyst (with video). Gastrointest Endosc 68:362–365

    Article  PubMed  Google Scholar 

  4. Ahlawat SK, Charabaty-Pishvaian A, Jackson PG, Haddad NG (2006) Single-step EUS-guided pancreatic pseudocyst drainage using a large channel linear array echoendoscope and cystotome: results in 11 patients. JOP 7:616–624

    PubMed  Google Scholar 

  5. Ang TL, Teo EK, Fock KM (2008) EUS-guided drainage of infected pancreatic pseudocyst: use of a 10F Soehendra dilator to facilitate a double-wire technique for initial transgastric access (with videos). Gastrointest Endosc 68:192–194

    Article  PubMed  Google Scholar 

  6. Evans JA, Conway JD, Mishra G (2010) A novel method for performing multiple wire insertions during endoscopic cyst gastrostomy. Gastrointest Endosc 71:612–614

    Article  PubMed  Google Scholar 

Download references

Disclosures

Kenneth F. Binmoeller is a consultant (chief medical officer) with an equity interest in Xlumena, Inc. Janak N. Shah is a consultant and advisory board member of Xlumena, Inc. Frank Weilert, Yasser Bhat, and Steve Kane have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Paul May and Frank Stein Center for Interventional Endoscopy, California Pacific Medical Center, San Francisco, CA, USA

    Kenneth F. Binmoeller, Frank Weilert, Janak N. Shah, Yasser M. Bhat & Steve Kane

Authors
  1. Kenneth F. Binmoeller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frank Weilert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janak N. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasser M. Bhat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steve Kane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kenneth F. Binmoeller.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (M4V 48416 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Binmoeller, K.F., Weilert, F., Shah, J.N. et al. Endosonography-guided transmural drainage of pancreatic pseudocysts using an exchange-free access device: initial clinical experience. Surg Endosc 27, 1835–1839 (2013). https://doi.org/10.1007/s00464-012-2682-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2682-9

Keywords

Search

Navigation