| Theme | Biliopancreatic Drainage and Stenting | |
|---|---|---|
| Title | EUS-guided Pancreatic Pseudocyst/Abscess Drainage | |
| Publish Date | 2012/04 | |
| Author | Mitsuhiro Kida | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Koshi Yamauchi | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Kosuke Okuwaki | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Shiro Miyazawa | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Tomohisa Iwai | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Hiroko Ikeda | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Miyoko Takezawa | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Masao Araki | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Hidehiko Kikuchi | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Maya Watanabe | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Hiroshi Imaizumi | Department of Gastroenterology, Kitasato University East Hospital |
| Author | Wasaburo Koizumi | Department of Gastroenterology, Kitasato University East Hospital |
| [ Summary ] | In general, pancreatic abscesses, which result from necrotizing pancreatitis and pseudocysts with infection, should be drained immediately, because they will result in patient death. The indications for drainage, including EUS-guided, endoscopic and percutaneous techniques are pseudocysts larger than 5-7 cm 4-8 weeks after treatment and exhibiting symptoms. In cases with pancreatic abscesses, endoscopic or EUS-guided drainage is indicated for treatment. Secondly, pseudocyts connected to the pancreatic duct should initially be treated with papillary stenting. In cases with insufficient functing, or no connection to the pancreatic duct, we employ EUS-guided drainage of pseudocysts close to the gastrointestinal tract when there is clearance of less than 10 mm. Percutaneous drainage is employed for the remaing cases. Finally, surgical drainage is performed in cases where there resistance has been to previous treatments. Recently, it has been reported that multiple drainage tubes are more effective than single drainage systems. Step up treatment, which means initial use of endoscopic and EUS-guided drainage, followed by percutaneous treatment, and finally surgical measures seems to be optimal. It has also been reported that pseudocysts treated only with initial treatments such as endoscopic or EUS-guided drainage tend to lead to fewer complications. | |