Full aspiration technique using a 7-Fr double-pigtail stent for endoscopic ultrasound-guided pancreatic fluid drainage of a pancreatic pseudocyst

Endoscopic ultrasound–guided pancreatic fluid drainage (EUS-PFD) is an established treatment for pancreatic pseudocysts 1. To prevent pseudocyst infection caused by stent occlusion, multiple plastic stents are often placed 2. However, when fistula dilation is difficult, placing two stents is technically challenging, and a single 7-Fr stent has been associated with an increased risk of stent occlusion 3. Large pseudocysts have also been associated with stent migration, especially when fluid drainage is insufficient 4 5. Achieving reliable drainage with fewer plastic stents remains challenging. We developed a “full aspiration technique” to place a single 7-Fr double-pigtail stent after aspirating all cystic fluid before stent release (Video 1). A 54-year-old man, who had undergone distal pancreatectomy for pancreatic cancer, presented with epigastric pain. Laboratory tests showed elevated white blood cell count and C-reactive protein. MDCT revealed a 66-mm cystic lesion in the pancreatic head, diagnosed as a pancreatic pseudocyst (Fig. 1). EUS-PFD was performed. After puncture with a 19G EZ Shot 3 needle (Olympus, Tokyo, Japan), bloody fluid was aspirated. As the cyst partially shrank and shifted, tract dilation became difficult. A drill dilator (Tornus ES, Olympus, Tokyo, Japan) was used, but tract dilation remained challenging. The cavity was re-expanded by injecting 20 mL of saline through a catheter and then dilated with a 4-mm REN balloon (Kaneka Medix, Osaka, Japan). A 7-Fr/7-cm double-pigtail stent (Through & Pass, Gadelius Medical, Tokyo, Japan) was deployed halfway, the guidewire was removed, and 85 mL of fluid was aspirated (Fig. 2 and Fig. 3). The stent was then released into the stomach. The procedure was completed without adverse events, and post-procedural computed tomography confirmed complete resolution (Fig. 4). This novel technique allows complete aspiration of the cystic fluid before stent release, reducing the risk of stent occlusion and migration by shrinking the cyst. EndoscopyUCTNCodeTTT₁AS₂AJ Article published online: 17 February 2026 © 2026. The Author (s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https: //creativecommons. org/licenses/by/4. 0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany