Differential treatment and early outcome in the interventional endoscopic management of pancreatic pseudocysts in 27 patients

Table 1 Interventional endoscopic approach of PPC: Indications and methodological aspects of the 3 different treatment groups (see also “Patients and methods” section above)

GROUP	Title	n	Indication	Method
I	Primary, percutaneous, ultrasound-guided placement of a drainage	9	Septic symptoms & inhomogeneous cystic content with suspected infection of PPC revealed by transabdominal ultrasound & EUS	-Ultrasound-guided puncture of the PPC -Aspiration of 10-20 mL of cystic fluid/content -Laboratory analysis (amylase, lipase, CEA, Ca19-9) -Microbiologic investigation for microbial detection/growth -Placement of a 10-Fr. pigtail drainage (Endoflex, Voerde, Germany) -Rinsing with 20-50 mL NaCl/h (bolus) via the drainage -Administration of antibiotics (ceftriaxone [Rocephin®, Hoffmann-La Roche AG, Grenzach-Wyhlen, Germany] plus metronidazol [Clont®, Bayer Vital GmbH, Leverkusen, Germany]) over 7 d
II	Primary, EUS-guided cystogastrostomy	13	Echo-free PPC with no inner echos & no evidence of infection	-Puncture of the cyst with 19-G needle (Wilson-Cook [Cook Deutschland GmbH], Mönchengladbach, Germany) -Cytologic investigation of cystic fluid/content -Placement of a 8.5-Fr.-double pigtail catheter Endoflex, Voerde, Germany) -Administration of antibiotics (ceftriaxone [Rocephin®, Hoffmann-La Roche AG, Grenzach-Wyhlen, Germany]) over 3 d
III	EUS-guided cystogastrostomy with following necrosectomy	5	-Suspected sequester & necrosis within the PPC revealed by ultrasound -Persisting fever & septic symptoms after cystogastrostomy & EUS- guided placement of a drainage	-Introduction of a 0.035-Inch guide wire (MTW Endoskopie, Wesel, Germany) via needle in place -Opening of the PPC with needle knife (Erbe Elektromedizin GmbH, Leipzig, Germany) -Enlargement of the PPC opening with balloon dilatation (Boston Scientific Medizintechnik GmbH, Ratingen, Germany) -Endoscopy of the cystic cavity -Removal of the necroses with loop & Dormia´s basket (MTW Endoskopie, Wesel, Germany, each) (min. 2x) -Microbiologic investigation for microbial detection/growth -Placement of a transgastrocystic 8.5-Fr.-double pigtail drainage (Endoflex, Voerde, Germany) -Removal of the pigtail catheter after 3-6 mo -Administration of antibiotics (ceftriaxone plus metronidazol) over 7 d