[A case of pancreatic pseudocyst associated with pancreatic cancer successfully treated with endoscopic pseudocyst drainage, which allowed continuation of chemotherapy].

We report a case of pancreatic pseudocyst associated with pancreatic cancer that was successfully treated with endoscopic pseudocyst drainage, which allowed continuation of chemotherapy. A 74-year-old woman complaining of jaundice was diagnosed with locally advanced cancer in the head of the pancreas, and she underwent chemotherapy with gemcitabine. One month later, she was admitted to our hospital for severe epigastralgia, and she diagnosed with a pancreatic pseudocyst that was 14 cm in diameter. Endoscopic ultrasonography-guided pseudocyst drainage was successfully performed. The amylase concentration of pseudocyst fluid was 13,320 U/L, and bacterial culture was negative. The epigastralgia soon resolved, but 1 week later, the size of the pseudocyst was 12 cm in diameter. Endoscopic retrograde pancreatography revealed communication of the pancreatic duct with the pseudocyst. A pancreatic stent was placed. The patient again underwent chemotherapy for 3 months, without major complications. The pseudocyst was no longer visible 3 months after stent placement. The patient died of pancreatic cancer with peritonitis carcinomatosa, 6 months after the initial diagnosis.

[Assessment of five-metallic stent placement cases for malignant duodenal stenosis].

We report five-metallic stent placement cases for malignant duodenal stenosis. Two of them received a placement of Ultraflex by over-the-wire (OTW) procedure, and the other three received a placement of WallFlex by through-the-scope (TTS) procedure. We assessed the baseline characteristic of the patient, procedural time and food intake after the stent placement for both OTW and TIS groups. OTW GROUP CASE 1: A 93-year-old woman with cancer of the ampulla of Vater, 60 min. in procedure time and low-residue diet after stent replacement. OTW GROUP CASE 2: A 76-year-old man with pancreatic cancer, 90 min. in procedure time and low-residue diet after stent replacement. TTS GROUP CASE 1: A 56-year-old man with recurrent postoperative bile duct cancer and gallbladder cancer, 16 min. in procedure time and full diet after stent replacement. TTS group case 2: A 79-year-old woman with pancreatic cancer, 40 min. in procedure time and liquids only after stent placement. TTS GROUP CASE 3: A 64-year-old woman with pancreatic cancer, 17 min. in procedure time and liquids only after stent placement. In comparison with OTW, TTS placement was much easier and it took a shorter procedural time. However, we consider that a selection of suitable stents and an assessment of the location for good food intake after stent placement are more important.