Endoscopic Ultrasonography (EUS) Drainage With Self-Expandable Metallic Stent (SEMS) in Pancreatic Pseudocyst (PP) and Pen-Pancreatic Abscess (PPA): A Prospective Study

Introduction EUS-guided PP and PPA drainage has become the standard and safer procedure in many centers but often requires repeated sessions, multiple stents placement, naso-cystic catheter placement and prolonged hospital stay. Aim To evaluate feasibility, safety and outcomes of temporary SEMS placement for the treatment of PP and PA. Material and Methods From June 2008 to July 2009 all patients with a CT diagnosis and with symptomatic PP and PPA were included in the study. All patients underwent EUS-guided puncture followed by cysto-gastrostomy and placement of a 10x40mm partially covered Wallflex biliary stent (Boston Scientific) or a fully covered Niti-S biliary stent (Taewoong). Results Ten patients (7 M and 3 F; mean age 55.9-12.3) with 7 PP and 3 PPA were recruited. Mean lesions size was 11.6-3.9 cm (range: 8-20 cm). The procedure was technically feasible in 9 out of 10 patients (90%): in one patient the large PP secondary to acute pancreatitis presented multiple spontaneous enteric fistulization. In 6 patients a partially covered stent was placed, while in the other 3 the fully covered stent. Transgastric and transduodenal approach were conducted in 6 and 3 cases, respectively. There were no procedure-related complications, but one patients with decompensated alcoholic cirrhosis and chronic pancreatitis enrolled for a PPA died 10 hours after the procedure for acute respiratory failure. In the remaining 8 patients PP and PA resolved without additional intervention after a median of 25.7-3.1 days, documented by CT and EUS. SEMS were removed without difficulty in 7 patients, while in one patient a partially covered stent with flogistic tissue ingrowth was impossible to remove endoscopically; this stent was removed during a surgical intervention for a renal disease. No PP and PPA recurrence was observed during the follow-up period (mean 212-75.4 days). Conclusions Endoscopic SEMS for PP and PPA is a safe and efficient endoscopic treatment. Higher cost of SEMS is probably offset by savings related to reduced number of procedures and hospital stay costs.