Endoscopic vacuum-assisted therapy of an infected pancreatic pseudocyst.

ious complications of acute and chronic pancreatitis [1–3]. Endoscopic vacuumassisted therapy (EVAT) is a reliable treatment for abscesses that are accessible endoscopically [4,5]. We report the first case in which EVAT was used in the treatment of an infected pancreatic pseudocyst. A 28-year-oldwomanwas admittedwith a severe inflammatory response syndrome (SIRS) due to a 20 cm infected pancreatic pseudocyst. We performed endoscopic ultrasound-guided transgastric puncture, dilated the transgastric access by balloon catheter (OlympusMedical Systems, Hamburg, Germany), and drained the pseudocyst using three 10-Fr double-pigtail endoprotheses (Medi-Globe, Achenmühle, Germany) and a nasocystic tube (PBD21Z; Olympus, Tokyo, Japan). Over the next 6 days, 1500mL normal saline per 24 hours was continuously injected into the cyst via the nasocystic tube. On the second and fifth days after the initial drainage, we again dilated the transgastric access to 14mm using a balloon catheter, intubated the cyst with the endoscope (GIF Q180, Olympus, Tokyo, Japan), and removed infected fluid and tissue in a Dormia basket (Endoflex, Voerde, Germany;●" Fig. 1). The cyst was therefore cleaned and the SIRS resolved; however, 7 days after the initial drainage, the pseudocyst had still not completely collapsed (●" Fig. 2). We removedall the endoprotheses, dilated the access to 16mm and started EVAT following insertion of the Endo-SPONGE system (B. Braun, Melsungen, Germany). The size of the sponge was adjusted according to the local topography and placed into the cyst by means of a grasping forceps and guidewire (Jagwire; Boston Scientific, Miami, USA;●" Figs. 3 and 4). The suction tube was extended with a nasogastric tube and secretions were continuously evacuated with a suction of 120mm Hg (16 kPa). All procedures were performed whilst the patient was under conscious sedation with midazolam and propofol. TheEndo-SPONGEsystemwas replacedon the third day. The wall of the cyst had become very well supplied with blood and Endoscopic vacuum-assisted therapy of an infected pancreatic pseudocyst