Endoscopic Ultrasound (EUS) guided transmural
drainage has become the first-line treatment of pancreatic fluid collections
(PFC). In most cases, transmural drainage may be successfully performed from
the stomach or duodenal bulb with the echo endoscope in a straight position.
However, seldom the location of the PFC in
relation to the luminal wall is in such a manner that a safe window for transmural drainage (≤ 1 cm from luminal wall) cannot be obtained
unless the echo endoscope is positioned deeper in the duodenum.
Endoscopic drainage from this position can be
technically challenging as the torqued scope shaft and angulated tip of the
echo endoscope results in poor maneuverability and difficulty advancing the
needle for PFC puncture and stent placement. Here we report a case of a
technically challenging EUS-guided PFC drainage
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