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2024-03-27

PERCUSCOPY

INTRODUCTION

Image-guided percutaneous catheter insertion for drainage of fluid collections is one of the therapeutic medical advances most important from the past century. The benefits of the method have been pointed out by distinguished surgeons such as Dr. Claude Welch on his New England Journal of Medicine editorial with reference to the landmark publication on computer tomography (CT) and ultrasound (US) guided percutaneous drainage by Dr. Gershoff (1-3). The most remarkable contribution of the technique referred to, either guided by CT or US, is to provide a safe, effective, and minimally invasive treatment alternative, replacing surgery to evacuate thoracic and abdominal fluid collections. DEFINITION Percuscopy (Lat. per = through; PIE, (s)keu =" cover, hide"; Gr. skopein = to look) (4,5) is the performance of diagnostic exploration and therapeutic maneuvers using videoendoscopy, through skin holes originally performed for image-guided placement of drainage catheters.

HISTORY AND BACKGROUND

Image-guided percutaneous catheter insertion for drainage of fluid collections can be traced back to the second half of past century (5-7). Originally consisting of insertion of single small diameter drainage catheters, the technique has evolved to the use of multiple and larger size catheters. This evolution was necessary for successful removal of necrotic debris from complex collections, such of pancreatic necrosis, previously requiring major and devastating repeated operations with dismal results. Additionally, progressive innovative operators introduced videoendoscopy to explore and add manipulations assisting to effective management of such conditions (8).

The term “percuscopy” was coined by Dr. D’Agostino, who first used the method on May 19, 1999, to explore and aspirate necrotic material with a nephroscope from a patient with necrotizing pancreatitis through left flank skin holes from percutaneous drainage catheters. By September that year, we presented 6 patients on whom we had done percutaneous videoendoscopy and removal of necrotic material (pancreatitis and cystic necrotic tumors) at the SMIT Congress, in Boston. The procedure was safe and successful and opened the opportunity for further work using scopes for different complex collections with particulate or necrotic debris including pancreatic fluid collections and cystic necrotic tumors (5). The experience was shared at the meeting of the Biliary Radicals Society, now discontinued, held at the time of the Radiological Society of North America in Chicago that year. After showing the percutaneous videoendoscopy in Buenos Aires, the technique was embraced by surgeons. Cases were added and a paper published in the Revista Argentina de Cirugia. in 2002. The procedure took off and there are now publications addressing the use of endoscopy inserted through drainage catheters skin holes and tracts. Therefore, in 2023 the term “percuscopy” is just accurately descriptive of the procedure. The advent of small diameter scopes for medical use in several specialties favors the development of new tools (Spy-Glass Discover, Boston Scientific) for having de option to allow percoscopy through the hole and tract of percutaneous drainage catheters.

Percuscopy allowed definitive improvement on the management of severe pancreatitis thanks to well-designed research trials (6-7). Results from those trials changed radically how patients with life threatening conditions from acute pancreatitis were treated. Additionally, they have allowed for better understanding of the disease which today has a much better prognosis (8,9). Percuscopy is an effective resource for palliative control of the symptoms caused by mass effect and sepsis from cystic necrotic tumors (10).

Overall, percuscopy es an emerging technique which offers the possibility to have direct vision of the lesions where percutaneous drainage catheters were inserted. Such benefit allows for tissue sampling, safe removal of tissue, and eventually more innovative challenging techniques as implants and anastomosis, patiently waiting to be developed.

REFERENCES

1.	Welch CE. Catheter Drainage of Abdominal Abscesses N Engl J Med 1981;305:694-695DOI: 10.1056/NEJM198109173051209 2.	Gerzof SG, Robbins AH, Johnson WC, Birkett DH, Nabseth DC. Percutaneous catheter drainage of abdominal abscesses: a five-year experience. N Engl J Med. 1981 Sep 17;305(12):653-7. doi: 10.1056/NEJM198109173051201. PMID: 7266601. 3.	https://www.etymonline.com/word/percutaneous 4.	https://www.etymonline.com/search?q=scope 5.	Holm HH, Kristensen JK, Rasmussen SN. Ultrasound as a guide in percutaneous puncture technique. Ultrasonics 1972; 10:83-86. 6.	Gerzof SG, Robbins AH, Birkett DH, et al. Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography. AJR 1979: 133:1-8. 7.	vanSonnenberg E, Mueller PR, Ferruci JT Jr. Percutaneous drainage of 250 abdominal abscesses and fluid collections. Part I: Results, failures and complications. Radiology 1984; 151:337-41. 8.	D’Agostino HR, Giménez ME, Guerrini N, de Gregorio M, Andreacchio A, Berkowski D, Agostini V, Defelitto J. “Videoscopía Percutánea En La Necrosis Pancreática Organizada;.” Volume 83 Jul -August 2002 Numbers 1-2. 9.	D'Agostino HR, Hamidian Jahromi A, Jafarimehr E, Johnson P, Do D, Henderson B,Chu Q, Shokouh-Amiri H, Zibari G. “Strategy for effective percutaneous drainage of pancreatic collections: results on 121 patients.” J La State Med Soc. 2013 Mar-Apr;165 (2):74-81. PMID: 23734536. 10.	Ballard DH, Mokkarala M, D'Agostino HB. Percutaneous drainage and management of fluid collections associated with necrotic or cystic tumors in the abdomen and pelvis. Abdom Radiol (NY). 2019 Apr;44(4):1562-1566. doi:10.1007/s00261-018-1854-z. PMID: 30506143; PMCID: PMC6440818.