A team from Marseilles, France, investigated the use of endoscopic ultrasound (EUS)-guided drainage for pancreatic pseudocysts or pancreatic abscesses.
This drainage technique used a therapeutic echo endoscope.
35 patients (29 men, mean age 57 years) with pancreatic pseudocysts or abscesses were enrolled in the study. EUS-guided drainage was conducted in each, between 1996 and1999.
The mean size of the 35 pancreatic cysts was 7.8 cm.
Pancreatic pseudocysts were located in the head of the pancreas in 2 cases, in the body in 6 cases, and in the tail in 7 cases.
|EUS-guided drainage of pancreatic cysts was successful in 89% of cases.
On the other hand, the pancreatic abscesses were located in the tail of the pancreas in 17 cases and in the gastric wall in 3 cases.
The EUS instrument used was the FG 38X endoscope, manufactured by Pentax-Hitachi.
No major complication occurred, except in one case of a pneumoperitoneum, which was managed medically.
Placement of the 7-F nasocystic drain was successful in 18/20 cases of pancreatic abscess. Surgery was performed in the 2 other patients.
Concerning the pancreatic pseudocysts, placement of an 8.5-French stent was successful in 10 patients and of a nasopancreatic drain in 5 patients. In one case, only a puncture-aspiration was performed.
The researchers observed 1 recurrence among the 15 pancreatic pseudocysts and 2 relapses of the 18 pancreatic abscesses. This was over a mean follow-up of 27 months.
Overall, EUS-guided drainage was found to be successful in 31/35 patients (89%). Only 4 patients with pancreatic abscesses underwent surgery.
No bleeding occurred during the time of this study.
Researcher M. Giovannini, of the Paoli-Calmettes Institute, Marseilles, concluded on behalf of the group, "Internal drainage of pancreatic pseudocysts and abscesses, exclusively performed with an echo endoscope, is a safe and efficient method. This should be evaluated further in larger studies."