Use of a novel transluminal balloon accessotome in transmural drainage of pancreatic pseudocyst (with video).

BACKGROUND: Endoscopic transmural pseudocyst drainage is a multistep procedure.

OBJECTIVE: Our purpose was evaluation of a new device, the transluminal balloon accessotome (TBA) in transmural drainage of pancreatic pseudocysts.

DESIGN: Case series.

SETTING: Subspecialty tertiary care center.

PATIENTS AND INTERVENTIONS: Between September and October 2007, all consecutive patients with symptomatic pancreatic pseudocysts in whom TBA was used for pseudocyst drainage were included. Through a therapeutic duodenoscope, the pseudocyst was punctured with the needle-knife of the TBA at the point of maximal bulge. After the cyst cavity was entered, the needle-knife and the handle of the TBA device were withdrawn and a 0.035-inch guidewire was passed into the cavity. The tract was dilated with the inflatable balloon of the TBA device, and a 10F double-pigtail was inserted.

RESULTS: Six patients, all male, median age 35 years, underwent transmural pancreatic pseudocyst drainage with TBA during this period. All procedures were completed successfully. There were no major complications during or after the procedure except for fever in 1 patient, which responded to parenteral antibiotics. At 6-week follow-up, the pseudocyst cavity had completely collapsed, and stents could be extracted in all patients.

LIMITATIONS: Single-center experience, small sample size.

CONCLUSIONS: TBA is a safe, useful, and easy-to-use device for transmural drainage of pancreatic pseudocysts.