Published online Oct 6, 2018. doi: 10.12998/wjcc.v6.i11.459
Peer-review started: May 13, 2018
First decision: June 5, 2018
Revised: June 16, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: October 6, 2018
Pancreatic pseudocyst (PPC), a common sequela of acute or chronic pancreatitis, was defined by the revised Atlanta classification as “a collection.” Endoscopic ultrasound (EUS)-guided drainage is often considered a standard first-line therapy for patients with symptomatic PPC. This effective approach exhibits 90%-100% technical success and 85%-98% clinical success. Bleeding is a deadly adverse event associated with EUS-guided drainage procedures, and the bleeding rate ranges from 3% to 14%. Hemostasis involves conservative treatment, endoscopy, interventional radiology-guided embolization and surgery. However, few studies have reported on EUS-guided drainage with massive, multiple hemorrhages related to severe pancreatogenic portal hypertension (PPH). Thus, the aim of this case report was to present a case using a balloon dilator to achieve successful hemostasis for PPH-related massive bleeding in EUS-guided drainage of PPC. To our knowledge, this method has not been previously reported.
Core tip: There has been considerable research in recent years dedicated to the development of endoscopic ultrasound-guided drainage, which is viewed as the first-line therapy for the management of pancreatic pseudocyst due to the minimized invasiveness, lower mortality, better physical and mental condition of patient compared with surgical and percutaneous approaches. Although the procedure is safe and effective, bleeding is one of the deadly adverse events. This is the first report using a balloon dilator to control pancreatogenic portal hypertension-related bleeding in endoscopic ultrasound-guided drainage for pseudocyst.