Tips for EUS-guided cystogastrostomy

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

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