A novel method for performing multiple wire insertions during endoscopic cyst gastrostomy

Background

Endoscopic cyst gastrostomy is effective in the management of uncomplicated pancreatic pseudocysts. A challenging aspect of the procedure is the insertion and confirmation of at least 2 guidewires into the cyst. Many technical procedures to accomplish the wire insertion have been described but are complicated.

Objective

We describe the use of a simple commercially available catheter that allows multiple wires to be inserted into a pancreatic pseudocyst as an efficient and simple means of performing a cyst gastrostomy.

Design

Case series.

Setting

Academic referral center.

Patients

Four consecutive patients undergoing EUS-guided cyst gastrostomy.

Interventions

A Haber ramp was used as the means for the introduction of multiple wires into a pancreatic pseudocyst.

Main Outcome Measurements

Technical success without loss of wire access during the cyst gastrostomy.

Results

Four patients underwent successful pancreatic cyst gastrostomy. There was no loss of wire access during the procedure. There were no intraprocedure or postprocedure complications.

Limitations

Small patient population.

Conclusions

The use of the Haber ramp provides a simple and efficient means for introducing, ensuring, and maintaining wire access during the creation of an endoscopic cyst gastrostomy.