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Effectiveness and safety of a single 7-French plastic stent for endoscopic ultrasound-guided pancreatic pseudocyst drainage and long-term follow-up outcomes

1 Department of Medicine, Siriraj GI Endoscopy Center, Division of Gastronterology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand, Thailand
2 Department of Internal Medicine, Division of Gastroenterology, Rajavithi Hospital, Bangkok, Thailand
3 Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand

Correspondence Address:
Nonthalee Pausawasdi,
Department of Medicine, Siriraj GI Endoscopy Center, Division of Gastronterology,, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700
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Source of Support: None, Conflict of Interest: None

Background: Endoscopic ultrasound (EUS)-guided cystogastrostomy with a single 7-French (Fr) double-pigtail stent (DPS) is less popular due to the concern of stent patency. We aimed to assess the effectiveness, complications, and long-term outcomes of a single 7-Fr DPS in the endoscopic drainage of uncomplicated pseudocysts, containing no or minimal (<10%) debris. Methods: A retrospective review of patients with pancreatic pseudocysts, who underwent EUS-guided cystogastrostomy during 2010–2018, and a systematic review of the literature were conducted. Results: Of 45 patients, 14 patients underwent endoscopic drainage of uncomplicated pseudocysts using a single 7-Fr × 5 cm DPS. The mean cyst size was 10.2 ± 3.5 cm. Stent placement had a 100% technical and clinical success, defined as complete resolution of symptoms and regression of the cyst size by more than 50% at 8 weeks after drainage. The median follow-up was 42.4 months (range, 10–103). The pseudocysts resolved without recurrence in 92.8%. Spontaneous stent dislodgment was noted in 70% at a mean follow-up of 18 months. Additional interventions were required in 14% of cases due to stent occlusion and migration. A systematic review of literature related to EUS-guided cystogastrostomy using single and multiple plastic stents included 9 of 333 studies (222 patients). The analysis showed the pooled clinical success of 89% (95% confidence interval [CI], 82.0–94.2) and complication rate of 13% (95% CI, 5.7–21.8). Conclusion: Selected uncomplicated pseudocysts can be treated effectively with a single 7-Fr DPS as it provides comparable clinical success and long-term outcomes as using larger or multiple stents.

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