Metal Stenting Improves Endoscopic Drainage of Large Pancreatic Pseudocysts: 258

Purpose: Stent placement in endoscopic drainage of pancreatic pseudocysts assures continuous cyst decompression and prevents early cystgastrostomy closure. Double pigtail plastic stents have been routinely used for this purpose; however, plastic stents may not provide adequate drainage in case of large (>10 cm) pseudocyst. We report our experience with fully covered metal stents for pancreatic pseudocyst drainage. Methods: Seven endoscopic cystgastrostomies with metal stent placement were performed between 2011 and 2013, and reviewed for procedure indication, cyst size, stent type and size, and complications. Results: All cystgastrostomies were endoscopic ultrasound guided. Abdominal pain was the most common indication for drainage; three patients had infected pseudocysts. Average patient age was 50 (35-65). Average cyst size was 15.9 cm (13-22 cm). Four 10 mm x 6 cm and three 10 mm x 8 cm fully covered metal biliary stents (Viabil, Gore) were used; in 5 out of 7 cases, plastic double pigtail stent was placed alongside metal stent. Average follow-up was 3.5 mo (1-6 mo). Pseudocysts resolved in all patients. There were no immediate complications; in one patient, metal stent migrated out into the stomach. Conclusion: In our experience, fully covered metal stents improve drainage of large pancreatic pseudocysts, leading to pseudocyst resolution with no immediate complications.Figure: Cystgastrostomy with metal stent.