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Transmural drainage of pancreatic pseudocysts: Endoscopic drainage or endoscopic ultrasonographic‐guided drainage?

under direct vision, EUS-guided drainage is also indicated in cases that do not have obvious bulging by pseudocyst, and bleeding during a puncture is less frequent because large vessels of the gastric wall can be avoided (Table 2). There are also some problems associated with EUS-guided drainage; placement of large bore tubes is limited due to the small working channel, and, in some cases, endoscopic drainage under direct vision may be controlled more easily than EUS-guided drainage. Recently, a new video-endosongraphy system with a 3.7 mm working channnel (Olympus, Tokyo, Japan) has become available, and a new device that enables one-step cyst puncture and stent insertion has been developed. Thus, some safety and technical problems associated with pancreatic pseudocyst drainage seemed to have been resolved. Endoscopic transmural drainage is considered to be an effective procedure in treating pancreatic pseudocysts. We performed nine cases of endoscopic cystogastrostomy (ECG) and three cases of cystoduodenostomy (ECD). Endoscopic drainage was successful in 11 out of the 12 patients, and the cysts were collapsed in 10 out of 11 cases (Table 1). Five complications ocurred after ECG (bleeding in two, pseudocyst infection in two and perforation in one). Bleeding could be controlled by endoscopic hemostasis, but an emergency operation was required in the patient with the perforation. Severe pseudocyst infection ocurred in two cases, presenting a large amount of debris in the cystic lumen. Endoscopic transmural drainage is an effective method in some cases, but the potential risk of severe complications must be discussed. Endoscopic ultrasonographic (EUS)-guided transmural drainage has been developed to reduce procedure-related Digestive Endoscopy (2001) 13 (Suppl.), S60