Endoscopic transmural drainage of pancreatic pseudocysts: results of a national and an international survey of ASGE members

Background: Pancreatic pseudocysts can be drained endoscopically via the transpapillary or the transmural routes. We sought to assess endoscopic methods of pseudocyst drainage. Methods: A web-based Survey was sent to American Society for Gastrointestinal Endoscopy (ASGE) members in the United States (U.S.) and internationally Results: Of the 3054 endoscopists to whom the Survey was sent, 266 (8.7%) replied; 198 performed pseudocyst drainage (103 [52%] ASGE members from the United States and 95 [48%] international members). The median of the total number of drainages per physician was 15 (range 1-364). The transgastric route was the most commonly used drainage route (65%). Transmural entry was performed by using a needle-knife in 53% of transmural drainages that were not EUS-guided. The number of stents placed ranged from 1 to 5 and these remained in place for 2 to 30 weeks. CT scan was used before drainage by 95% of all respondents. EUS imaging was used before drainage by 72 of 103 (70%) US endoscopists compared with 56 of 95 (59%) international endoscopists (p = 0.1). EUS-guided drainage was used by 56% of US endoscopists compared with 43% international endoscopists (p = 0.06). Conclusions: The most common site of transmural entry for drainage of pancreatic pseudocysts appears to be the transgastric route. Although CT is the most commonly used predrainage imaging modality, EUS is used before and during transmural drainage of pseudocysts in both the U.S. and abroad, particularly in academic medical centers. Use of EUS before or during drainage does not appear to be significantly different among endoscopists in the United States and internationally.