The exclusion criteria

were impaired coagulation, pregnancy, and patient refusal. We used a silicone-covered nitinol stent, 16 mm in diameter and Selleck Sorafenib 30 mm long, that was specially designed for temporary gastrocystostomy (Nagi stent, Taewoong-Medical Co, Ltd, Gyeonggi-do, Korea) (Fig. 1). This FCSEMS was short enough to reduce the degree of protrusion. The diameter was flared at both ends to 26 mm to provide stability and minimize the risk of migration. The enteric end bore a retrieval suture. The diameter of the delivery system was 10F, so the stent could be inserted via an endoscope. All procedures were performed with patients under conscious sedation with diazepam and pethidine hydrochloride. US endoscopes (GF-UCT240 or GF-UCT260; Olympus, Tokyo, Japan) were used. EUS-guided transgastric puncture was performed by using a 19-gauge needle (Echotip-19, Cook Endoscopy, Winston-Salem, NC). The puncture site was dilated to 4 mm or 6 mm (PET balloon dilator; ConMed Co, Utica, NY), the FCSEMS delivery system was inserted, and the stent was deployed (Fig. 2). Placement of a transnasal drainage tube for irrigation and DEN through the FCSEMS were left to the endoscopists’ discretion (Fig. 3). An endoscope with a water jet channel was used for DEN (GIF-260J, 9.9 mm diameter; Olympus). If DEN was planned for the management of WOPN, the tract was dilated to 15 mm (CRE balloon; Boston Scientific, Natick, Mass). Therapeutic endoscopy

(GIF-260J; Olympus) was used for DEN. If

DEN was planned for the management of WOPN, the tract was dilated to 15 mm (CRE balloon; Boston Scientific). Antibiotics were administered intravenously before the procedure until the level of C-reactive Buparlisib in vitro protein was normalized. Anti-acid drugs such as proton-pump inhibitors were not administered. Oral intake was restarted if the patients did not have both pain and severe complications after the procedure. The amount of fluid collection was evaluated by weekly CT scans after the procedure P-type ATPase until the shrinkage, and an additional imaging test was performed at the doctors’ discretion. The stent was removed endoscopically after the complete disappearance of the PFC was confirmed by CT scan. However, the timing for removal was determined by the patient’s condition. A follow-up study by CT scan was performed approximately 8 weeks after removal of the stent whenever possible. The success rate, complications, and removability were evaluated. Technical success was defined as the correct placement of the FCSEMS. Clinical success was defined as complete shrinking of the PFC or infection resolution without surgical treatment. Early (≤7 days) and late (≥8 days) complications were noted. Table 1 shows the treatment data. Nine patients (5 with pancreatic pseudocyst and 4 with WOPN) underwent endoscopic treatment of PFCs with the newly developed FCSEMS from 7 to 40 days after the onset of pancreatitis. Six of the 9 cases involved suspected disconnected duct syndrome.