Transgastric percutaneous drainage of pancreatic pseudocysts.

Transgastric pancreatic pseudocyst drainage provides unique advantages that mimic the benefits of surgical cystogastrostomy while avoiding the disadvantages of external drainage. This procedure was performed under CT guidance in eight patients with pancreatic pseudocysts. There was no communication with the pancreatic duct at the time of initial aspiration. Communication was later demonstrated in six of eight patients and persisted for the entire duration of drainage. Resolution of the cysts occurred in seven of the eight patients. In one patient an infection of the pancreatic collection developed that required surgery. As with abdominal abscess drainage, a preexisting fistula may be opacified only after several days of catheter drainage and cannot be predicted at the time of initial aspiration. The percutaneous transgastric approach mimics the surgical approach and allows a mature tract to form from the cyst to the stomach. This eliminates the risk of a pancreaticocutaneous fistula and permits tube removal within a reasonable period of time.