Strategic International Session2(JGES・JSGE・JSGS)
Fri. November 3rd   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
Cases of bleeding after endoscopic ultrasound guided pancreatic pseudocyst drainage
Ryunosuke Hakuta1, Yousuke Nakai2, Mitsuhiro Fujishiro1
1Department of Gastroenterology, The University of Tokyo, 2Department of Endoscopy and Endoscopic Surgery, The University of Tokyo
[Aim]EUS-guided drainage of pancreatic pseudocyst (PC) is the current standard of care but early adverse events can occur. We reported two cases of bleeding after EUS-guided drainage of PC (EUS-PCD).
[Case1]74-years-old man with chronic pancreatitis complicated symptomatic 8-cm PC was admitted. EUS-PCD with a double pigtail plastic stent (DPS) was planned. PC in the head of pancreas was punctured, followed by guidewire insertion. Despite the use of color Doppler EUS, overt intracystic arterial bleeding was observed on EUS image after needle removal. A 15-mm lumen-apposing metal stent (LAMS) was placed with successful hemostasis. One month later, after confirmation of the absence of aneurysm, LAMS was removed without bleeding.
[Case2]36-years-old man with a previous history of acute pancreatitis was admitted due to symptomatic PC. EUS-PCD using DPS was successfully performed after non-enhanced CT due to impaired renal function. However, he was readmitted for recurrent pain after two weeks. At reintervention for additional nasocystic drainage placement, a large defect suggesting necrotic tissue within PC was seen on fluoroscopy. Contrast-enhanced CT was performed prior to necrosectomy, which revealed a 3.3-cm pseudoaneurysm within PC. The pseudoaneurysm was successfully managed by trans-arterial coil embolization.
[Conclusion]EUS-PCD can be complicated by intra- or post-procedure bleeding, and endoscopic or trans-arterial hemostasis should be selected based on the cause and location of bleeding.
Index Term 1: bleeding
Index Term 2: EUS guided drainage
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