• Consensus
• Diagnosis and treatment
• Pancreatic pseudocyst
• Walled-off necrosis

• Endoluminal robotics
• Endoscopic full thickness resection
• Endoscopic submucosal dissection
• Third space endoscopy

• cystgastrostomy
• endoscopy
• intragastric
• laparoscopy
• pancreatic pseudocyst
• ultrasound

Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo OverStitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty.

• Endoscopic suturing
• Peroral endoscopic myotomy
• Endoscopic full thickness resection
• Natural Orifice Transluminal Endoscopic surgery
• Endoscopic bariatric surgery
• Endoscopic sleeve
• Transoral outlet reduction

• Complications
• Conservative treatment
• Interventional therapy
• Severe acute pancreatitis
• Therapeutics

• Acute Disease
• Anti-Bacterial Agents/therapeutic use
• Cholangiopancreatography, Endoscopic Retrograde
• Combined Modality Therapy
• Drainage/methods
• Enteral Nutrition/methods
• Fluid Therapy
• Humans
• Magnetic Resonance Imaging
• Pancreatitis/complications
• Pancreatitis/diagnosis
• Pancreatitis/therapy
• Pancreatitis, Acute Necrotizing/complications
• Pancreatitis, Acute Necrotizing/diagnosis
• Pancreatitis, Acute Necrotizing/therapy
• Parenteral Nutrition/methods
• Severity of Illness Index
• Tomography, X-Ray Computed

• Bariatric cyst-gastrostomy
• Pancreatitis
• Pseudocyst

• endoscopic ultrasound
• pancreatic pseudocyst
• upper gastrointestinal bleeding
• portal hypertension

• Adult
• Drainage/adverse effects
• Endosonography
• Hemorrhage/etiology
• Hemorrhage/therapy
• Humans
• Male
• Pancreatic Pseudocyst/surgery
• Stents
• Ultrasonography, Interventional

Laparoscopic cystenteric drainage of pancreatic pseudocysts remains feasible even after major open abdominal procedures.

Symptomatic pancreatic pseudocysts can be drained using open, endoscopic, and laparoscopic techniques. Little is written on the role of laparoscopic drainage techniques after major abdominal operations. We describe a case of laparoscopic cystgastrotomy after pancreaticoduodenecomy.

A 55-year-old female with a prior history of open pylorus-preserving pancreaticoduodenectomy presented with multiple symptomatic pancreatic pseudocysts in the setting of alcohol-induced chronic pancreatitis.

After preoperative planning with contrast-enhanced computed tomography, the patient successfully underwent laparoscopic cystgastrotomy with ultrasonic dissection.

This case report illustrates that laparoscopic cystenteric drainage of pancreatic pseudocysts can be performed safely after major open abdominal operations. Further investigation is needed.

• Algorithms
• Cholangiopancreatography, Endoscopic Retrograde/methods
• Cooperative Behavior
• Diagnosis, Differential
• Drainage/methods
• Endosonography/methods
• Gastrostomy/methods
• Humans
• Image Interpretation, Computer-Assisted/methods
• Interdisciplinary Communication
• Jejunostomy/methods
• Laparoscopy/methods
• Magnetic Resonance Imaging/methods
• Pancreatic Neoplasms/diagnosis
• Pancreatic Pseudocyst/diagnosis
• Pancreatic Pseudocyst/etiology
• Pancreatic Pseudocyst/surgery
• Recurrence
• Stents
• Ultrasonography/methods
• Ultrasonography, Interventional

Pancreatic fluid collections (PFCs) develop secondary to either fluid leakage or liquefaction of pancreatic necrosis following acute pancreatitis, chronic pancreatitis, surgery or abdominal trauma. Pancreatic fluid collections include acute fluid collections, acute and chronic pancreatic pseudocysts, pancreatic abscesses and pancreatic necrosis. Before the introduction of linear endoscopic ultrasound (EUS) in the 1990s and the subsequent development of endoscopic ultrasound-guided drainage (EUS-GD) procedures, the available options for drainage in symptomatic PFCs included surgical drainage, percutaneous drainage using radiological guidance and conventional endoscopic transmural drainage. In recent years, it has gradually been recognized that, due to its lower morbidity rate compared to the surgical and percutaneous approaches, endoscopic treatment may be the preferred first-line approach for managing symptomatic PFCs. Endoscopic ultrasound-guided drainage has the following advantages, when compared to other alternatives such as surgical, percutaneous and non-EUS-guided endoscopic drainage. EUS-GD is less invasive than surgery and therefore does not require general anesthesia. The morbidity rate is lower, recovery is faster and the costs are lower. EUS-GD can avoid local complications related to percutaneous drainage. Because the endoscope is placed adjacent to the fluid collection, it can have direct access to the fluid cavity, unlike percutaneous drainage which traverses the abdominal wall. Complications such as bleeding, inadvertent puncture of adjacent viscera, secondary infection and prolonged periods of drainage with resultant pancreatico-cutaneous fistulae may be avoided. The only difference between EUS and non-EUS drainage is the initial step, namely, gaining access to the pancreatic fluid collection. All the subsequent steps are similar, i.e., insertion of guide-wires with fluoroscopic guidance, balloon dilatation of the cystogastrostomy and insertion of transmural stents or nasocystic catheters. With the introduction of the EUS-scope equipped with a large operative channel which permits drainage of the PFCs in “one step”, EUS-GD has been increasingly carried out in many tertiary care centers and has expanded the safety and efficacy of this modality, allowing access to and drainage of overly challenging fluid collections. However, the nature of the PFCs determines the outcome of this procedure. The technique and review of current literature regarding EUS-GD of PFCs will be discussed.

• Endoscopic ultrasound-guided drainage
• Pancreatic fluid collections
• Pseudocysts
• Pancreatic abscesses
• Infected necrosis

Since the first description of the concept of natural orifice translumenal endoscopic surgery (NOTES), a substantial number of clinical NOTES reports have appeared in the literature. This editorial reviews the available human data addressing research questions originally proposed by the white paper, including determining the optimal method of access for NOTES, developing safe methods of lumenal closure, suturing and anastomotic devices, advanced multitasking platforms, addressing the risk of infection, managing complications, addressing challenges with visualization, and training for NOTES procedures. An analysis of the literature reveals that so far transvaginal access and closure appear to be the most feasible techniques for NOTES, with a limited, but growing transgastric, transrectal, and transesophageal NOTES experience in humans. The theoretically increased risk of infection as a result of NOTES procedures has not been substantiated in transvaginal and transgastric procedures so far. Development of suturing and anastomotic devices and advanced platforms for NOTES has progressed slowly, with limited clinical data on their use so far. Data on the optimal management and incidence of intraoperative complications remain sparse, although possible factors contributing to complications are discussed. Finally, this editorial discusses the likely direction of future NOTES development and its possible role in clinical practice.

• Natural orifice translumenal endoscopic surgery
• Outcomes
• Complications
• Endoscopic
• Surgery