A335 EUS-GUIDED CYSTOGASTROSTOMY IN MANAGING PANCREATIC PSEUDOCYST-PORTAL VEIN FISTULA WITH REFRACTORY HEPATIC ABSCESS
Bibliographic record
Abstract
Pancreatic pseudocysts can fistulise into the portal venous system and seed to the liver with subsequent abscess formation. Percutaneous drainage and antibiotics may only offer temporary improvement. We look at the role of EUS-guided cystogastrostomy and metal stent insertion in facilitating definitive resolution of secondary infected hepatic pseudocysts. In the case of a 64-year-old presenting with abdominal pain, CT abdomen showed a pancreatic pseudocyst, portal vein thrombosis and a multiloculated liver lesion. Despite antibiotics for presumed liver abscess, he later re-presented with enlargement of both liver cyst and pancreatic pseudocyst, communicating with the pancreatic duct and portal vein on CT imaging. Fluid from the liver cyst showed an elevated amylase level. The pseudocyst did not fully resolve with CT-guided percutaneous drainage, so we did an EUS-guided cystogastrostomy with plastic double-pigtail stent insertion. Follow-up CT, however, showed pseudocyst enlargement, requiring further EUS-guided cystogastrostomy and fully covered metal stent insertion. Follow-up CT two months later showed almost complete resolution of both liver and pancreatic collections. For a 54-year-old also presenting with abdominal pain, abdominal CT identified an ill-defined, multiloculated liver mass and extensive portal venous thrombosis. The liver abscess was treated with antibiotics and drainage. Three months later, he re-presented and abdominal CT showed complex fluid within the portal venous system, suspicious of a pancreatic origin. MRCP confirmed a pancreatic ductal stricture with decompression into a pseudocyst and evidence of secondary cavernous transformation of the portal vein extending into the liver. Percutaneous aspiration of the large liver cyst confirmed amylase-rich fluid. We proceeded with EUS-guided cystogastrostomy and fully covered metal stent deployment. Abdominal CT two weeks later showed successful decompression of the pseudocyst and resolving liver cyst. These patients demonstrate that secondary liver pseudocysts, refractory to percutaneous drainage, may resolve completely after decompression of their feeding “primary” pancreatic pseudocyst through EUS-guided cystogastrostomy and metal stenting. Failure of percutaneous drainage alone may be explained by persistent feeding with proteolytic material via the connection between the primary pseudocyst and portal vein. In conclusion, liver fluid collections may develop in association with pancreatic pseudocysts through an “embolic” phenomenon mediated through the portal venous system. Furthermore, failure of liver cyst resolution could be attributed to ongoing “feeding” from its parent pancreatic pseudocyst. We suggest that consideration be given to EUS-guided pancreatic cystogastrostomy and metal stent placement for long-term resolution. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".