Cysto-gastrostomy under EUS guidance is used for the drainage of pancreatic fluid collections (PFCs). It can be done using plastic or lumen-apposing metal stents (LAMS).
Here’s 10 tips for EUS-guided cysto-gastrostomy, by Shyam Varadarajulu for World Endoscopy Organization (WEO):
- Use MRI as the modality of choice to evaluate a PFC
- Check for disconnected pancreatic duct syndrome (DPDS)
- If no history of pancreatitis, consider a diagnosis of cyst neoplasm
- In patients with unexplained pancreatitis, examine the pancreatic parenchyma proximal and distal to the PFC for a mass – there may be an underlying neoplasm
- Take into account patient-related factors, PFC type (pseudocyst versus walled-off necrosis/WON) and the presence of DPDS in choosing between plastic or metal stents
- Reevaluate the patient 72 hours after the drainage procedure to determine the need for necrosectomy
- Get the right scopes and accessories to maximize technical efficiency
- Consider repeating the intervention in patients with persistence of a PFC after transmural stent placement
- Don’t forget the timing for stent removal