Endoscopic Ultrasound – Guided Drainage Using A Combination Of A Nasocystic Drain And Transmural Stents

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Endoscopic ultrasound- guided transmural drainage of debris by using endoprosthesis and a nasocystic drain for the management of pancreatic pseudocysts. Research on the endoscopic treatment of pseudocyst have considered the use of one or more hollow stents or tiny tubes (called endoprosthesces), These tiny tubes are inserted into the pseudocysts to drain into the stomach (or duodend lumen) alone for transgastric of transduodual drainage. Endoscopic ultrasound guide drainage is as effective as surgery and causes very little side effects and is cheaper than surgery. Traditionally pseudocyst had been done surgically. The result of surgical procedure had 35% adverse event rate and mortality of 10%.

Endoscopic ultrasound (EUS) uses a flexible endoscope which has a small ultrasound devise, it can be used to create small visual images in the digestive tracts, the oesophagus, small bowels, colon and the stomach. The ultrasound components create a sound wave which penetrates the inner surface lining and helps also to see images in the other adjacent organs

A pancreatic pseudocyst is made up of localized fluid collection which is sealed in a fibrous wall of reactive tissue that is adjacent to the pancreas. In acute pancreatitis (inflammation of the Pancreas) at least 10% to 20% of patients have pseudocysts. In chronic pancreatitis- Pseudocysts occur in 20% to 40% patients.

Drainage is prescribed for patients having persistent intra-abdominal symptoms (i.e., abdominal pain, early stage nausea, vomiting), Cyst related adverse events (biliary obstruction, or infection) or when the cyst increase in size. When detection of diseases by other tests is inconclusive the endoscopic ultrasound is used to diagnose disease of the pancreas, gall bladder and the bile duct. Endoscopic ultrasound can also detect cancer at its various stages.

In patients with viscous debris laden-fluid a combination of nasocystic drain and transmural stents improves clinical outcome, this also lowers the stent occlusion rate. This is in comparsion to those who had undergone drainage through stent alone.

The management of symptomatic pseudocysts by pancreatic endoscopic ultrasound has been made the standard procedure for the diagnosis and treatment of pseudocyst. However the presence of debris within a pseudocyst may impair success of endoscopic drainage, as it may lead to premature stent occlusion (blockage). The researchers hypothesized that the presence of solid-debris with pseudocysts which lead to occlusion could be avoided by early saline solution irrigation using nasocystic tube to prevent occlusion and to achieve adequate drainage.

The researcher concluded that endoscopic ultrasound-guided drainage of pseudocysts with viscous solid debris-laden fluid via nasocystic drain alongside transmural stents resulted in lower occlusion rate and better clinical results when compared with the results of drain done with transmural stents alone. This study shows that pancreatic pseudocysts drainage with both endoprosthesis(stents) and nasocystic drainage is safe and has a high success rate.

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