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Endoscopic drainage of pancreatic fluid collections: Long-term outcomes in children
Zaheer Nabi1, Sundeep Lakhtakia1, Jahangeer Basha1
1Asian Institute of Gastroenterology, Hyderabad, India.
Insights
Endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFC) is safe and effective in children, with high success rates and manageable adverse events. This minimally invasive approach offers a viable treatment option for pediatric patients with PFC.
Area of Science:
- Pediatric Gastroenterology
- Interventional Endoscopy
- Pancreatic Diseases
Background:
- Pancreatic fluid collections (PFC) management is standard in adults, but data in children is limited.
- Endoscopic drainage is the preferred method for PFC in adults.
Purpose of the Study:
- To evaluate the safety and long-term efficacy of endoscopic ultrasound (EUS)-guided drainage of PFC in pediatric patients.
- To assess technical feasibility, clinical success, and adverse events of EUS-guided drainage in children.
Main Methods:
- Retrospective analysis of pediatric patients (<18 years) who underwent EUS-guided drainage of PFC using plastic stents.
- Data collected included technical success, clinical efficacy, and adverse events.
Main Results:
- Successful EUS drainage in 96.7% of 30 children (mean age 13.07 years).
- Clinical success achieved in 93.3% of cases, with a median follow-up of 829 days.
- Adverse events included perforation, bleeding, and stent migration; two recurrences of PFC were noted.
Conclusions:
- EUS-guided drainage with plastic stents is a safe and effective treatment for pediatric PFC.
- Cystogastric plastic stents can be safely used long-term in children.
- Further research with larger cohorts is needed to confirm findings.
Background And Aim:
Endoscopic drainage of pancreatic fluid collections (PFC) is the standard of care in adult patients. The literature is limited in children. In the present study, we aim to evaluate the safety and long-term efficacy of endoscopic ultrasound (EUS)-guided drainage of PFC in children.
Methods:
Data of all children (<18 years) with PFC who underwent EUS-guided drainage with plastic stents were analyzed retrospectively for technical feasibility, clinical efficacy and adverse events (AE).
Results:
Thirty children (boys 22, girls 8) with PFC underwent EUS drainage (January 2013 to June 2016). Mean age of children was 13.07 ± 3.41 years (5-17 years). Majority of children had idiopathic pancreatitis (23), followed by trauma-related (6) and gallstone-related pancreatitis (1). Of 30 PFC, 13 (43.3%) and 17 (56.7%) were classified as pseudocyst and walled-off necrosis, respectively. Median size of PFC was 95 mm (61-175). EUS drainage was successfully completed in 29 children (technical success 96.7%). Clinical success was achieved in 28/30 (93.3%) children. AE included perforation (2), major bleed (1), minor bleed (2), stent migration (4) and readmission as a result of hematemesis (1). Imaging revealed disconnected pancreatic duct in nine, ductal leak in two and stricture in one child. Cystogastric stents were left in situ in children with disconnected duct. At median follow up of 829 days (150-1230), two recurrences of PFC were noticed.
Conclusions:
EUS-guided drainage using plastic stents is safe and effective in children with PFC. Cystogastric plastic stents can be left safely long term. However, more studies with larger sample sizes are required.