Novel endoscopic management for pancreatic pseudocyst with fistula to the common bile duct

Figure 1 Coronal computed tomography reconstruction showed a large pancreatic pseudocyst with a fistulous communication (arrow) to the common bile duct.

Figure 2 Pancreatic pseudocystis intervention. First step: Endoscopic ultrasound-guided puncture with 19-gauge dedicated needle of the pancreatic collection containing necrotic debris (A); Second step: Placement of the first plastic stent and two guidewire into the pseudocysts (PPs) for the placement of the second stent and the nasocystic drain (B); Third step: Fluoroscopic image showing the biliary stent (arrowhead), two PPs double pigtail stents and the nasocystic drain (C).

Figure 3 Computed tomography scan performed three weeks later: Scan reconstruction showing the correct position of the biliary and pancreatic collection stents (A), while the axial scan show almost complete resolution of the cystic cavity (B).

Figure 4 At endoscopic retrograde cholangiopancreatography performed 3 mo later, complete healing of the fistula was documented (arrow).