EUS-guided pseudocyst drainage as a one-step procedure using a novel multiple wire insertion technique.

technique of endoscopic ultrasound (EUS)-guided pseudocyst drainage as a one-step procedure using a novel multiple wire insertion technique facilitated by the double-lumen biliary cytology brush catheter (Cook Medical, Winston-Salem, North Carolina, USA). Six symptomatic patients underwent EUS-guided pseudocyst drainage using the novel multiple wire insertion technique (●" Video 1). After ensuring that there was less than 1 cm distance between the gastric wall and the pseudocyst and excluding the presence of vasculature in the path of the needle by means of color Doppler ultrasonography, a 19-gauge needle as employed in fine-needle aspiration was used to puncture the pseudocyst under EUS guidance. A 0.035-inch guide wire was then introduced through the needle and coiled inside the pseudocyst. Subsequently, the tract was sequentially dilated over the guide wire using an endoscopic retrograde cholangiopancreatography cannula and/or a Soehendra biliary dilator, followed by dilation with a CRE Wireguided Balloon Dilator (Boston Scientific, Natick, Massachusetts, USA). The balloon was then removed, leaving the guide wire coiled in the cyst. A double-lumen biliary cytology brush catheter was used to facilitate placement of multiple guide wires into the cyst cavity as follows. The brush was completely retracted and removed from the sheath. The device was thus modified into an 8-Fr catheter with two lumens, each of which EUS-guided pseudocyst drainage as a one-step procedure using a novel multiple wire insertion technique