Interventional radiology-assisted transgastric endoscopic drainage of peripancreatic fluid collections

Interventional radiology-assisted transgastric endoscopic drainage of peripancreatic fluid collections

Can J Surg 2020;63(3):E254-E256 | PDF | Appendix

Jeffrey Hawel, MD; Heather McFadgen, MD; Riley Stewart, MD; Tarek El-Ghazaly, MD; Abdulrahim Alawashez, MD; James Ellsmere, MD

Summary

Peripancreatic fluid collections (PFCs) occur as a consequence of pancreatitis. Most PFCs resolve spontaneously, although 1%–2% persist and may require intervention. Conventional transluminal endoscopic drainage methods require the PFC to be bulging into the gastric wall; however, it is not uncommon for this to be absent. Imaging guidance for transluminal endoscopic PFC drainage allows the endoscopist to localize nonbulging pseudocysts that cannot be localized using endoscopy alone, to identify and avoid vascular structures between the cyst and the gastric lumen, and to reveal solid or necrotic components within the pseudocyst cavity. Although endoscopic ultrasound (EUS) has been used to meet this need, timely access to therapeutic EUS remains a limiting factor at many centres. We report our technique and experience performing transgastric endoscopic drainage of PFCs under computed tomography (CT) interventional radiology guidance.


Accepted Sept. 17, 2019

Affiliations: From the Division of General Surgery, Dalhousie University, Halifax, NS.

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.003019

Correspondence to: J. Ellsmere, Division of General Surgery, Dalhousie University, QEII HSC — VG Site 8-818, Halifax NS B3H 2Y9, james.ellsmere@dal.ca