We report a case of pseudo cyst accompanied by acute pancreatitis which was successfully
treated by endoscopic cyst-gastrostomy. It had been enlarged recurrently after
twice simple needle aspiration under ultrasonic monitoring. Because of the infection of
the cyst, rapid and complete drainage was needed. Upper gastro-intestinal endoscopy
showed a large bulge of the stomach which was compressed by paragastric pancreatic
cyst. Endoscopic ultrasonography revealed that the cyst wall was attached hard with the
stomach and there was no vessels between them. Endoscopic fenestration of the bulge
was created using papillotome and diathermic snare. The drainage was effective and cyst
was decompressed rapidly. The fenestration was closed after the cyst was diminished.
Recently the endoscopic cyst-gastrostomy made by cutting linearly or inserting catheter
have been reported, however, these treatments sometimes resulted in infection and
relapse because of the quick closure of the fistula. When the bulge is large and endoscopic
ultrasonogram revealed low bleeding risk, the fenestration may be advisable for
effective drainage of longer duration without infection.
Severe acute pancreatitis caused by endoscopic ultrasonography-guided fine-needle biopsy of a pancreatic solid pseudopapillary neoplasm
