Endoscopic Ultrasound-Guided Transmural Drainage of Postoperative Pancreatic Collections  Amy Tilara, MD, Hans Gerdes, MD, Peter Allen, MD, FACS, William Jarnagin, MD, FACS, Peter Kingham, MD, Yuman Fong, MD, FACS, Ronald DeMatteo, MD, FACS, Michael D'Angelica, MD, Mark Schattner, MD  Journal of the American College of Surgeons  Volume 218, Issue 1, Pages 33-40 (January 2014) DOI: 10.1016/j.jamcollsurg.2013.09.001 Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 1 Endoscopic ultrasound (EUS) transmural drainage (TD) technique. (A) CT scan of the abdomen/pelvis showing a postoperative pancreatic fluid collection (arrowhead) that developed 11 days after pancreatic surgery. (B) EUS image showing a hypoechoic area consistent with a perigastric fluid collection. (C–F) Fluoroscopic images of EUS-TD. A fine aspiration needle was used to puncture the fluid collection under EUS guidance. A guidewire was introduced through the needle and coiled within the cavity under fluoroscopic guidance. After dilation of the tract with a dilation catheter, a second guidewire was coiled into the cavity. One 10F × 5-cm double pigtail stent was inserted, followed by a second 7F × 7-cm double pigtail stent into the fluid collection. (G) CT scan of abdomen/pelvis showing resolution of the fluid collection 1 month after the procedure with transgastric stents still in good position. Journal of the American College of Surgeons 2014 218, 33-40DOI: (10.1016/j.jamcollsurg.2013.09.001) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 2 Indications for pancreatic surgery. IPMN, intraductal papillary mucinous neoplasm. Journal of the American College of Surgeons 2014 218, 33-40DOI: (10.1016/j.jamcollsurg.2013.09.001) Copyright © 2014 American College of Surgeons Terms and Conditions