S80 Assessing the Safety and Efficacy of a Novel Endoscopic Ultrasound-Guided Cystotome in Drainage Procedures

Introduction: The cystotome is a novel endoscopic ultrasound (EUS)-guided electrosurgical accessory that facilitates EUS-guided transmural drainage of Pancreatic Fluid Collections (PFCs). This study aims to assess the safety and efficacy of cystotome-assisted PFC drainage. Methods: A retrospective analysis was conducted. The procedure involved the identification of an appropriate location via Color Doppler to avoid interposed vessels, cyst puncture, and insertion of an angled wire. Subsequently, the EUS-guided cystotome was introduced to dilate the fistula where stents were placed. Technical success was defined as the successful insertion of the cystotome and the creation of an appropriate drainage tract. Clinical success was defined as the improvement in patients’ symptoms. Long-term outcomes included recurrence rates, the need for additional procedures, and long-term resolution of PFC complications. Results: A total of 14 patients (mean age 56.8 ± 15.6, 35.7% women) were included. The majority of PFCs were pseudocysts (71.4%) with an average size of 51.27 × 40.47 mm (±27.95 × 21.37). The procedure had technical and clinical success rates of 100 and 83.3%, respectively. No intraprocedural complications were observed. The overall postprocedural complications were observed in 14.3% of patients, including 1 moderate complication (pseudocyst infection) and 1 severe complication (hypoxemic respiratory distress). Long-term success was achieved in 75% of patients with 1 case of recurrence and 2 cases requiring re-intervention. Conclusion: The cystotome is a safe and effective tool for EUS-guided PFC drainage, demonstrating high technical and clinical success rates with an acceptable complication profile. Prospective studies are needed to further validate its role in complex cases.