Effectiveness and safety of a single 7-French plastic stent for endoscopic ultrasound-guided pancreatic pseudocyst drainage and long-term follow-up outcomes
Nonthalee Pausawasdi1, Manus Rugivarodom1, Pongprueth Rujirachun1, Phunchai Charatchareonwitthaya1, Tanyaporn Chantarojanasiri2, Yongyut Sirivatanauksorn3
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
Department of Medicine, Siriraj GI Endoscopy Center, Division of Gastronterology,, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700
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.