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NATIONAL SCIENTIFIC CONGRESS ON GASTROENTEROLOGY 2016 THE PRELIMINARY RESULTS OF EUS-GUIDED PANCREATIC PSEUDOCYST DRAINAGE IN CHO RAY HOSPITAL Ho Dang Quy Dung, Ngo Phuong Minh Thuan Pham Huu Tung, Tran Dinh Tri Endoscopy Department, Cho Ray Hospital Introduction • Pancreatic Pseudocyst (PPC) – Fluid collections existed more than weeks – Causes: AP, CP and pancreatic trauma… – Surrounded by a nonepithelial wall of fibrous or granulation tissue – Contents essentially no solid material PP PP Banks P.A., Bollen T.L et al “Classification of acute pancreatitis-2012: revision of the Atlanta classification and definitions by international consensus” Introduction PPC treatment •Management of PPC has traditionally been surgical – Highly effective – Complication rate of 35% and a mortality of 10% •Percutaneous puncture and aspiration under ultrasonography/CT guidance or Percutaneous drainage – High recurrence rates – Complication rate ranging from 5% to 60%: fistula formation, infection and bleeding •Endoscopic pseudocyst drainage - Transmural drainage - Transpapillary drainage Introduction PPC treatment •Endoscopic transmural drainage – Non EUS-guided PP drainage – EUS-guided PP drainage + Effective + High success rate + Less complications We conducted this study: “The preliminary results of EUS-guided pancreatic pseudocyst drainage in Cho Ray hospital” Study Aims • To Evaluate the preliminary results of technical success rate, complication rate of EUS-guided pancreatic pseudocyst drainage in Cho Ray hospital • To Evaluate efficacy of EUS-guided pancreatic pseudocyst drainage in Cho Ray hospital PATIENTS AND METHODS Patients: All of patients underwent EUS-guided PP drainage in Cho Ray hospital from October 2015 to July 2016: •Patient critera: - Symptomatic PPC patients - History: AP, CP, pancreatic trauma - Cyst: > ws, > 6cm in diameter - Distance from PP to wall < 1cm - Minimal or no necrosis Pseudocyst PATIENTS AND METHODS • Exclusion criteria: - Pancreatic cystic neoplasms - Distance from PP to wall > 1cm - WON Methods: • Cross-sectional descriptive study PATIENTS AND METHODS • Equipments and accessories: - EUS system with linear ultrasound scope - C-arm - Accessories : 19G FNA needle, catheter, guidewire, balloon dilatator, double pigtail stent, nasocystic tube… Technique • Step 1: Cyst access - Transmural: 19G EUS FNA needle - Transpapillary: catheter, guidewire • Step 2: Tract Dilation - Catheter - Balloon • Step 3: Stent placement - Double pigtails plastic stent - Nasocystic tube Phillip S.G., Mikhala W et al “Pancreatic Pseudocysts: Advances in endoscopy management” Gastroenterol Clin N Am 45 (2016) 9-27 Technique Technique Results Common characteristics: •We had 20 patients underwent EUS-guided PP drainage in Cho Ray hospital from October 2015 to July 2016 - Median age: 39,065 ± 11 (20ys-62ys) - Male:Female ratio = 5,7 : Technical success: 100% (20/20 patients) Clinical success: 88% (15/17 patients) Complications: 15% (2 cyst infection and stent migration) Results Causes of PPC: NB: AP, pancreatic trauma are the most common causes of PPC Results Pancreatic Pseudocyst characteristics: Pancreatic Pseudocyst characteristics Cyst location on CT scan Head of Pancreas (15%) Body and tail of Pancrease 17 (85%) Median cyst size on US (mm) 118.7 ± 34.5 [68-209] mm Median cyst size on CT scan (mm) 132.2 ± 39.8 [70-234] mm NB: - Body and tail pancreas is the most common location of PPC - Size of the PPC are quite big (> 120mm) Results Efficacy and complications: Result Number (n, %) Define Technique 20/20 (100%) Successful placement stent Efficacy 15/17 (88%) Improved clinical symptoms and cysts are completely drainaged Complications 3/20 (15%) Cyst Infection (2 Pts), Stent migration (1 Pt) Tổng 20 (BN) Cyst Infection and stent migration are mild complications Results Results of cyst fluid: Cyst fluid Result Features Color (Clear / dark brown) 14/6 Most of PPC have quite clear fluid Amylase (mean) 43 640.39 (U/L) High level on most of PP CA 19.9 (mean) 1343.89 (ng/ml) Inscrease on few cases CEA (mean) 1.81 (ng/ml) Nomal Most of study PPCs showed: clear fluid color and high amylase level Discussion Technique - Techniques: + stent type: double pigtails, nasocystic-sonde, SEMS + stent size: 7- 8.5 F + Numbers of stent: 1-2 stent - Cyst access site: straight and short scope, feasible, no vessel (doppler), the nearest distance of PPC – wall - Transpapillary drainage: small cyst, comunication between cyst and pancreatic duct … EUS-guide and Non EUS-guide drainage p0.05 Hồ Đăng Quý Dũng CS (2014), Tạp chí Y Dược lâm sàng 108, 9, tr 72-77 ... Accessories : 19G FNA needle, catheter, guidewire, balloon dilatator, double pigtail stent, nasocystic tube… Technique • Step 1: Cyst access - Transmural: 19G EUS FNA needle - Transpapillary: catheter,... 17 (85%) Median cyst size on US (mm) 118.7 ± 34.5 [68-209] mm Median cyst size on CT scan (mm) 132 .2 ± 39.8 [70-234] mm NB: - Body and tail pancreas is the most common location of PPC - Size... PPC have quite clear fluid Amylase (mean) 43 640.39 (U/L) High level on most of PP CA 19.9 (mean) 134 3.89 (ng/ml) Inscrease on few cases CEA (mean) 1.81 (ng/ml) Nomal Most of study PPCs showed: