Response:

We thank Dr. Gyökeres for his comments. Indeed, percutaneous opacification of a pseudocyst after aspiration of its contents for biochemical, bacteriologic, and cytologic analysis was a useful adjunct to endotherapy before the availability of EUS- puncture. We also were using that technique in some cases in which opacification of the cyst was not obtained by means of the transpapillary route, particularly when there was complete rupture of the main pancreatic duct1Deviere J Bueso H Baize M Azar C Love J Moreno E et al.Complete disruption of the main pancreatic duct: endoscopic management.Gastrointest Endosc. 1995; 42: 445-451Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar and when the collection did not produce a bulge that was clearly visible at endoscopy. Nowadays, however, with the availability of therapeutic echoendoscopes, there is no need for percutaneous opacification because the contents of the cyst are sampled during EUS-guided procedure, either through the puncture or the diathermic needle itself. Moreover, EUS-guided therapy provides access to collections that are at a distance from the gut wall and for which, even after opacification of the collection, the imprint of the needle is not clearly visible at fluoroscopy. We thank Dr. Gyökeres for his comments. Indeed, percutaneous opacification of a pseudocyst after aspiration of its contents for biochemical, bacteriologic, and cytologic analysis was a useful adjunct to endotherapy before the availability of EUS- puncture. We also were using that technique in some cases in which opacification of the cyst was not obtained by means of the transpapillary route, particularly when there was complete rupture of the main pancreatic duct1Deviere J Bueso H Baize M Azar C Love J Moreno E et al.Complete disruption of the main pancreatic duct: endoscopic management.Gastrointest Endosc. 1995; 42: 445-451Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar and when the collection did not produce a bulge that was clearly visible at endoscopy. Nowadays, however, with the availability of therapeutic echoendoscopes, there is no need for percutaneous opacification because the contents of the cyst are sampled during EUS-guided procedure, either through the puncture or the diathermic needle itself. Moreover, EUS-guided therapy provides access to collections that are at a distance from the gut wall and for which, even after opacification of the collection, the imprint of the needle is not clearly visible at fluoroscopy.