Endoscopic Cystogastrostomy – A Minimally Invasive Solution for Pancreatic Fluid Collections

Overview of Endoscopic Cystogastrostomy

Endoscopic Cystogastrostomy is a highly specialized endoscopic procedure designed to drain pancreatic fluid collections — such as pancreatic pseudocysts or walled-off necrosis (WON) — into the stomach or the small intestine through a natural internal pathway.

These collections often develop as a complication of pancreatitis, abdominal trauma, or pancreatic duct leakage. If left untreated, they can cause persistent pain, infection, digestive discomfort, or compression of nearby organs.

With modern technology, cystogastrostomy can now be performed entirely through the mouth using an endoscope, eliminating the need for open or laparoscopic surgery. This internal drainage procedure promotes faster healing, minimal discomfort, and quicker recovery while preserving natural anatomy.

Understanding Pancreatic Fluid Collections

The pancreas is a gland located behind the stomach that produces digestive enzymes and hormones such as insulin.

After acute or chronic pancreatitis, the damaged pancreatic ducts may leak digestive fluids into the surrounding tissue, forming fluid-filled sacs. These can be of two main types:

• Pancreatic pseudocyst: A well-defined, non-infected fluid collection lined by fibrous tissue.
• Walled-off necrosis (WON): A more complex collection containing fluid and solid necrotic debris from pancreatic tissue damage.

While small, asymptomatic collections may resolve spontaneously, larger or symptomatic cysts often require drainage — and endoscopic cystogastrostomy has become the preferred, safe, and effective method for this.

When Is Endoscopic Cystogastrostomy Recommended?

Your doctor may recommend this procedure if you have:

• Persistent abdominal pain or bloating due to a fluid collection pressing on the stomach or intestines.
• Nausea, vomiting, or early satiety (feeling full quickly).
• Infected or enlarging pancreatic pseudocyst.
• Walled-off necrosis with fever or sepsis.
• Obstruction of the bile duct or duodenum caused by the cyst.

By creating a direct internal drainage route between the cyst and stomach, the fluid is safely emptied into the digestive tract, where it is naturally absorbed and removed.

How the Procedure Works – Step-by-Step

Endoscopic Cystogastrostomy is performed by an experienced interventional gastroenterologist using an echo-endoscope (endoscope combined with ultrasound imaging). The steps include:

• Preparation: The patient is asked to fast for several hours before the procedure. Sedation or general anesthesia ensures complete comfort throughout.
• Localization of the Cyst: The endoscope is advanced through the mouth into the stomach or duodenum. Using endoscopic ultrasound (EUS), the doctor precisely locates the fluid collection adjacent to the stomach wall and identifies a safe access site.
• Creating the Connection (Cystogastrostomy): Under real-time ultrasound guidance, a small opening is created between the cyst and the stomach wall.
• Insertion of Stent for Drainage: A special metal or plastic stent (often a Lumen-Apposing Metal Stent, LAMS) is placed across the opening. This stent allows continuous drainage of the cyst contents into the stomach.
• Confirmation: The correct position and drainage are confirmed endoscopically and by ultrasound imaging.
• Post-Procedure Monitoring: The patient is observed for a few hours and typically discharged within a day or two. The stent may remain in place for several weeks until the cavity fully resolves, after which it can be removed endoscopically.

This entire procedure is performed internally — no external incisions, no scars, and minimal recovery time.

Clinical Benefits of Endoscopic Cystogastrostomy

• Minimally Invasive: Performed through natural openings, avoiding external cuts or drains.
• Precision and Safety: Ultrasound guidance ensures accurate targeting of the cyst.
• Faster Recovery: Short hospital stay and quicker return to normal activities.
• Effective Drainage: Provides long-term resolution of pseudocysts and walled-off necrosis.
• Organ Preservation: Maintains pancreatic and gastric anatomy without surgical disruption.
• Improved Quality of Life: Relieves pain, restores digestion, and prevents infection or recurrence.

For most patients, symptoms improve within days of drainage, and follow-up imaging confirms gradual shrinkage and healing of the cyst cavity.

Follow-Up and Long-Term Care

After cystogastrostomy, periodic check-ups ensure that the stent is functioning properly and the collection has completely resolved. The doctor may recommend:

• Repeat endoscopy or imaging (CT/EUS) to confirm resolution.
• Removal or replacement of the stent once drainage is complete.
• Lifestyle modifications such as a low-fat diet, avoiding alcohol, and managing recurrent pancreatitis risk factors.
• In cases of walled-off necrosis, additional endoscopic necrosectomy (removal of dead tissue) may be performed through the same stent channel if required.

In Summary

Endoscopic Cystogastrostomy is a minimally invasive, image-guided procedure that has revolutionized the management of pancreatic fluid collections. By allowing internal drainage under precise ultrasound control, it provides safe and effective relief from symptoms while avoiding open surgery.

This technique exemplifies the progress of modern therapeutic endoscopy — delivering advanced treatment with reduced pain and faster recovery.

Doctor’s Message / Call to Action

If you have a pancreatic cyst, don’t worry — most can be treated without surgery. Book an appointment with Dr. Hitendra K Garg to understand your condition and get the right care. Simple, safe, and effective treatment starts here.