EUS Guided Pseudocyst drainage: Prospective evaluation of short term placement of fully covered self expanding metal stents followed by pancreatic ductal stenting (The BIDS Protocol)

This was a single-center prospective evaluation. All patients with symptomatic pancreatic fluid collection with a well-defined wall will be included in the study for placement of SEMS into the pancreatic pseudocyst followed by pancreatic ductal stenting via ERCP if MRCP demonstrates pancreatic ductal leak.

The patient will be kept under observation for 72 hours. Oral liquids will be allowed after 4 hours if the patient was asymptomatic. Intravenous antibiotics will be continued for 72 hours.  Ultrasound for assessment will be done at 24 hr followed by Gastroscopy after 72 hours for necrosectomy. Cyst cavity will be cleaned of any debris by lavage (100 ml normal saline, 10 ml Hydrogen peroxide 6% and povidone-iodine 10% w/v), necrosectomy and suction if debris is present. Follow-up: Patients will be followed-up at 3 monthly intervals with clinical examination and abdominal ultrasonography for one year. Definitions Technical success will defined as successful stent placement. Functional success will be defined as a residual cyst size of <2 cm on abdominal USG 24 hours after the procedure. The Lexicon criteria7 will be used to grade the adverse events. Recurrence will be defined as symptomatic recurrent fluid collection after complete resolution, in the same location as prior pseudocyst on follow-up abdominal ultrasonography.