Endoscopic Fenestration of Pseudo Cyst in Acute Pancreatitis

We report a case of pseudo cyst accompanied by acute pancreatitis which was successfully treated by endoscopic cyst-gastrostomy. It had been enlarged recurrently after twice simple needle aspiration under ultrasonic monitoring. Because of the infection of the cyst, rapid and complete drainage was needed. Upper gastro-intestinal endoscopy showed a large bulge of the stomach which was compressed by paragastric pancreatic cyst. Endoscopic ultrasonography revealed that the cyst wall was attached hard with the stomach and there was no vessels between them. Endoscopic fenestration of the bulge was created using papillotome and diathermic snare. The drainage was effective and cyst was decompressed rapidly. The fenestration was closed after the cyst was diminished. Recently the endoscopic cyst-gastrostomy made by cutting linearly or inserting catheter have been reported, however, these treatments sometimes resulted in infection and relapse because of the quick closure of the fistula. When the bulge is large and endoscopic ultrasonogram revealed low bleeding risk, the fenestration may be advisable for effective drainage of longer duration without infection.