Ultrasound-guided day-case wide-bore percutaneous mucin aspiration in advanced pseudomyxoma peritonei

•Percutaneous mucin aspiration for pseudomyxoma peritonei is a day case procedure. •Safe, effective procedure in cases of recurrent disease following debulking surgery. •Accumulation of mucin causes intestinal obstruction which is eventually fatal. •Used for palliative symptom control or for pre-operative optimisation. AIM To evaluate percutaneous ultrasound-guided day-case mucin aspiration in advanced pseudomyxoma peritonei (PMP) using a wide-bore drain with regards to its safety and efficacy. MATERIALS AND METHODS All patients who underwent percutaneous mucin aspiration for PMP between 2019–2021 at a single national peritoneal tumour service were included in this study. Under local anaesthesia, a suction-enabled 28–32 F catheter was used for drainage following wire-guided track dilatation. The volume drained and difference in abdominal girth pre- and post-procedure were measured. Patients graded difficulty in breathing and abdominal discomfort pre- and post-procedure. Histology reports were reviewed. RESULTS Sixteen patients received 56 percutaneous mucin aspirations between 2019–2021. The aetiology was a low-grade appendiceal mucinous neoplasm (LAMN) in 50% of patients. The mean amount of mucin drained was 7,320 ± 3,000ml (range 300–13,500 ml). The mean reduction in abdominal girth post-procedure was 12.2 ± 5 cm (range 0–27 cm). Only grade 1 complications were observed. CONCLUSION Percutaneous ultrasound-guided day-case aspiration of mucin for advanced and recurrent PMP using a wide-bore drain is a safe and effective procedure. It may be used in the palliative setting or as a bridge to surgery in the very symptomatic patient or if there is a reversible contraindication to surgery. To evaluate percutaneous ultrasound-guided day-case mucin aspiration in advanced pseudomyxoma peritonei (PMP) using a wide-bore drain with regards to its safety and efficacy. All patients who underwent percutaneous mucin aspiration for PMP between 2019–2021 at a single national peritoneal tumour service were included in this study. Under local anaesthesia, a suction-enabled 28–32 F catheter was used for drainage following wire-guided track dilatation. The volume drained and difference in abdominal girth pre- and post-procedure were measured. Patients graded difficulty in breathing and abdominal discomfort pre- and post-procedure. Histology reports were reviewed. Sixteen patients received 56 percutaneous mucin aspirations between 2019–2021. The aetiology was a low-grade appendiceal mucinous neoplasm (LAMN) in 50% of patients. The mean amount of mucin drained was 7,320 ± 3,000ml (range 300–13,500 ml). The mean reduction in abdominal girth post-procedure was 12.2 ± 5 cm (range 0–27 cm). Only grade 1 complications were observed. Percutaneous ultrasound-guided day-case aspiration of mucin for advanced and recurrent PMP using a wide-bore drain is a safe and effective procedure. It may be used in the palliative setting or as a bridge to surgery in the very symptomatic patient or if there is a reversible contraindication to surgery.