EUS-guided pancreatic pseudocyst drainage using the new “link” nitinol metallic stent

Background and aim: Pancreatic pseudocysts can be drained by surgical,alternative to surgery, but has the limitation that is a “blind” approach, with a significant risk of bleeding and perforation. Endoscopic ultrasound (EUS)-guided drainage of pancreatic pseudocysts is a credible alternative to drainages via the surgical or percutaneous route. Various techniques for pseudocyst drainage under EUS guidance have been described in the literature. We describe a case of single-step EUS-guided pseudocyst drainage, using a new nitilon metallic stent. Material and methods: A 67 years old male patients, affected by alcoholic chronic pancreatitis referred to us for diffuse abdominal pain. A contrastenhanced CT showed a 8 cm pseudocyst in the pancreatic tail and portal thrombosis, whereby we decided to perform an EUS-guided endoscopic drainage. Using a linear echoendoscope Pentax we confirmed the pseudocyst and after excluding vessels with doppler, we used a 10 Fr cystotome (Wilson-Cook) to elecrosurgically obtain a transmural puncture of pseudocyst. Then a guidewire was passed through the inner catheter into the cyst cavity. The guidewire position was confirmed using fluoroscopy. The outer sheath of cystotome was advenced through the puncture site using electrocautery to enlarge it. After removing cystotome we successfully placed a Niti-S biliary full covered 10 mm x 20 mm stent (“Link”, TaeWoong Medical). Results:We soon observed a good cystic liquid drainage. A contrast-enhanced CT performed two days after showed a successful pseudocyst drainage with cyst size reduction and stent correct placement. Patient clinical conditions were good. Conclusions: Single-step EUS-guided drainage with the new Niti-S biliary stent (“Link”) is an effective, safe and time sparing approach to pseudoscyst drainage.