Single-step, natural orifice transluminal endoscopic incision drainage of a pancreatic pseudocyst: can it be simpler, safer and more cost effective?

Conventional endotherapy for pancreatic pseudocyst involves placement of stents in the cyst cavity. We have successfully treated bulging pseudocyst in a 50 year old male by endoscopic incision drainage (EID), without insertion of endoprostheses. The presenting complaints in our patient were epigastric mass and postprandial vomiting. He had recently undergone open cholecystectomy following recovery from gallstone pancreatitis. EID was performed under general anaesthesia. Needle knife was advanced through the accessory channel of a flexible gastroscope. Cyst contents were evacuated by making 5 cm horizontal incision on the gastric indentation with dramatic relief in symptoms. There is no cyst recurrence during follow up for over 3 years.