Interventional radiology followed by endoscopic drainage for pancreatic fluid collections associated with high bleeding risk: Two case reports

Abstract

BACKGROUND

Endoscopic ultrasound (EUS)-guided transluminal drainage is an advanced technique used to treat pancreatic fluid collections (PFCs). However, gastric varices and intervening vessels may be associated with a high risk of bleeding and are, therefore, listed as relative contraindications. Herein, we report two patients who underwent interventional embolization before EUS-guided drainage.

CASE SUMMARY

Two 32-year-old males developed symptomatic PFCs after acute pancreatitis and came to our hospital for further treatment. One patient suffered from intermittent abdominal pain and vomiting, and computed tomography (CT) imaging showed an encapsulated cyst 7.93 cm × 6.13 cm in size. The other patient complained of a mass inside the abdomen, which gradually became enlarged. Gastric varices around the ideal puncture site were detected by EUS when we evaluated the possibility of endoscopic drainage in both patients. Interventional embolization was recommended as the first procedure to decrease the risk of bleeding. After that, EUS-guided transluminal drainage was successfully conducted, without vascular rupture. No postoperative complications occurred during hospitalization, and no recurrence was detected at the last follow-up CT scan performed at 1 mo.

CONCLUSION

Interventional embolization is a safe, preoperative procedure that is performed before EUS-guided drainage in PFC patients with gastric varices or at high risk of bleeding.

Keywords: Interventional embolization; Endoscopic drainage; Endoscopic ultrasound; Pancreatic fluid collections; Gastric varices; Case report

Core Tip: Endoscopic ultrasound-guided drainage has previously proved to be an excellent method to cure pancreatic fluid collections (PFCs). However, it is not recommended for PFCs with the gastric varices and the abundant surrounding vessels because of the high bleeding risk. Preoperative interventional embolization decreases the possibility of hemorrhage when a transluminal tunnel is established between the stomach and cyst. In our cases, the patients underwent this new preoperative arrangement and transgastric drainage was performed. No bleeding or other intraoperative complications occurred. We recommend this modality as a new strategy for PFCs drainage in patients with high bleeding risk.