Torontofiles: Cystgastrostomy, traditional technique

 Traditional technique No. 1

Equipments: 10 Fr Cook Cystotome, 6-8mm CRE balloon, 2 JAG wires

Step 1: 

1) Remove the 10 Fr outer sheath. Then, puncture the cavity with the internal 0.038 needle knife (Autocut Effect 4/ 100W) inside the 5Fr sheath, and advance both in to cyst cavity

2) Once in the cavity, remove the 0.038 needle knife and advance a 0.035 JAG wire through the 5Fr sheath.

3) Then, advance the 10 Fr outer sheath (with diathermy ring) over the 5Fr sheath. The 10 Fr sheath is advanced in to the cyst cavity using ERBE (Forced coagulation, E2,30W).

4) The 5 Fr sheath is removed, and a second 0.035 JAG wire is inserted.

5) The 10 Fr sheath is then removed. The cyst-gastrostomy tract is then dilated by passing a 6-8 mm CRE balloon over one of the two 0.035 JAG wires, and dilating the tract to 8 mm.

6) Two pigtail stents are then inserted, one each over the JAG wire.













Traditional Technique 2:


Equipments needed: Optimos (Taewong), Oasis stent pusher system, 2 JAG wires, CRE balloon


The optimos (Taewong) 6 Fr cystotome has a tapered metal tip, to enable the cutting and doesnt have a removable knife. It saves 1 step compared to above.


Step 1 - Puncture the cyst cavity with the 6 Fr Optimos cystotome, and advance in to cavity

Step 2 - Once in the cavity, insert a 0.035 JAG wire. Then, remove the cystotome over the wire.

Step 3 - Using CRE, dilate the tract to 8 mm over the JAG wire

Step 4 - Use Oasis pushing catheter (white hollow sheath), and insert it over the JAG wire in to cyst cavity. Then insert a second 0.035 JAG wire through the white sheath

Step 5 - Insert two plastic stents as above.



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