RESUMEN
Introduction: Endoscopic ultrasound (EUS)-guided pancreatic cysto-gastrostomy/duodenostomy is the current accepted practice for management of symptomatic pancreatic pseudocysts with insertion of two or more double-pigtail (DP) stents. There is no much work on the efficacy of using a single wide-caliber DP stent, aiming to decrease the time, complications, and accessories used in the procedure. Aim of the Work: The aim of this study was to assess technical and clinical outcomes of using a single wide-caliber DP stent in EUSguided pancreatic pseudocyst drainage. Methodology: This multicenter prospective study included 57 patients, from which the 35 patients with symptomatic pancreatic pseudocysts enrolled. Patients with cysts with multiple septations (7 cases) or cyst with >30% necrosis (8 cases) of the cyst content and patients with generalized ascites (4 cases) or patients with major comorbidities (3 cases) were excluded. Patients were followed up within 1 month and 6 months after stent placement to assess complete resolution or a decrease in the sizes of cysts with clinical symptomatic improvement. Results: From 57 patients, 35 patients (19 females/16 males, median age 40 years) with a symptomatic pancreatic pseudocyst were referred for EUS-guided drainage. All used stents were 10 Fr DP plastic stents. The median duration of the whole procedure was 16 min. Technical success was achieved in all cases. Clinical success was encountered in 32 patients (91.4%) without re-accumulation on follow-up. Minor adverse events were encountered in 3 patients (8.6%) including post-procedure abdominal pain (1 case) and fever (2 cases). Conclusion: We suggest that using a wide-caliber single-pigtail stent for EUS-guided cystogastrostomy is safe and effective with short procedure time, with reduced risks from the insertion of another stent(s).
Introdução: A cistogastrostomia/duodenostomia pancreatica guiada por ecoendoscopia (EUS) e atualmente aceite para a abordagem dos pseudoquistos pancreaticos sintomaticos atraves da insercao de dois ou mais stents duplo pigtail (DP). A evidencia e escassa relativamente a eficacia da utilizacao de apenas um stent duplo pigtail de grande calibre, com o objetivo de diminuir o tempo, as complicacoes e os dispositivos utilizados no procedimento. Objetivo: Avaliar os resultados tecnicos e clinicos do uso de stent duplo pigtail unico de grande calibre na drenagem de pseudoquistos pancreaticos guiada por ecoendoscopia. Metodologia: Estudo prospetivo multicentrico incluindo 57 doentes (dos quais 35 com pseudoquistos pancreaticos sintomaticos). Foram excluidos pacientes com quistos multiseptados (7 casos), com necrose >30% (8 casos), com ascite (4 casos) e comorbidades major (3 casos). O follow-up foi ao 1 mes e 6 meses apos a colocacao do stent para avaliar a resolucao completa ou diminuicao no tamanhos dos pseudoquistos com melhoria sintomatica. Resultados: Dos 57 doentes, 35 (19 mulheres/16 homens, idade media 40 anos) com pseudoquistos pancreaticos sintomaticos foram submetidos a drenagem guiada por EUS. Todos os stents utilizados foram stents DP plasticos com 10 Fr. A duracao mediana do procedimento foi de 16 minutos. O sucesso tecnico foi alcancado em todos os casos. Ocorreu sucesso clinico em 32 doentes (91,4%), sem reacumulacao no seguimento. Eventos adversos menores ocorreram em 3 doentes (8,6%), incluindo dor abdominal pos-procedimento (1) e febre (2). Conclusão: Os resultados sugerem que a utilizacao de stent pigtail unico de grande calibre para cistogastrostomia guiada por EUS e segura e eficaz, com tempo de procedimento curto e reduzindo o risco da insercao de outro(s) stent(s).