Endoscopic Ultrasound-Guided Ethanol Lavage of A Pancreatic Fluid Collection

A 30-year-old man with a history of alcohol abuse developed a large pseudocyst (89 × 78 mm) in the tail of the pancreas (Figure [1]) following a single episode of acute severe pancreatitis with multiple organ dysfunction syndrome. As the patient declined any form of surgery, endoscopic decompression of the pseudocyst was carried out with real-time endoscopic ultrasound (EUS) guidance (Figure [2]) after informed consent had been obtained. With the patient under general anesthesia, EUS was conducted with a Pentax FG-36UA ultrasound endoscope (Pentax Europe, Ltd., Hamburg, Germany) using a curved-array transducer with fluoroscopic guidance [1]. The pseudocyst was visualized as a bulge on the posterior gastric wall, and the shortest access route (about 10 mm) in which there were no interposed vessels was clearly identified. A 19-Fr needle (Cook Medical Inc., Bloomington, Indiana, USA) was introduced through the endoscope’s working channel to puncture the pseudocyst and inject 30 ml iopromide (Ultravist) contrast. No communication with the pancreatic duct was visible.