Soehendra stent retriever--a useful device for pancreatic pseudocyst drainage.

A 52-year-old patient with chronic pancreatitis was admitted for drainage of two symptomatic pancreatic pseudocysts. Endoscopic ultrasonography (EUS) showed pseudocysts in the pancreatic body and head of 50×40mm and 30×20mm in size, respectively. We first performed transgastric drainage of the pancreatic body pseudocyst, using a lumen-apposing stent. In the same session, we approached the pancreatic head pseudocyst. A transduodenal puncture of the cyst wasmadewith a 19-gauge needle (●" Fig.1). A cystotome was used, but it failed to get through the hard and thick cystic wall (●" Fig.2a). A throughthe-scope balloon dilation was attempted, but without success. A 10-Fr Soehendra stent retriever (SSR) was then introduced through the scope over the guidewire (●" Fig.2b). As when it is used for difficult biliary stenoses [1,2],weperformed clockwise rotational movements while pushing the device into the cavity (●" Fig.3). This maneuver finally allowed access to the pseudocyst, which was confirmed by outpouring of the contents of the cyst into the duodenum (●" Fig.4a). A double-pigtail stent (8.5Fr, 4cm) was inserted (●" Fig.4b;●" Video 1), allowing efficient drainage. The authors present this case to demonstrate the usefulness of the SSR, extending its utility, not only in difficult biliary stenosis but also as a device that may allow access into pancreatic pseudocysts with a hard and thick wall.