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Updated: Jan 21, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Pancreatic pseudocyst drainage in children by image-guided cystogastrostomy and stent insertion
Premal A Patel1,2, Craig Gibson3, Kishore S Minhas4
1Interventional Radiology, Radiology Department, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, UK. premalpatel@doctors.org.uk.
Insights
Image-guided drainage of pancreatic pseudocysts in children using a novel stent is feasible and safe. This minimally invasive technique achieved complete resolution in most cases with no complications.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Minimally Invasive Surgery
Background:
- Endoscopic ultrasound is rarely available in pediatric centers.
- Traditional surgical drainage of pancreatic pseudocysts in children is common.
- This study explores an alternative minimally invasive approach.
Purpose of the Study:
- To assess the feasibility and safety of image-guided internal drainage of pediatric pancreatic pseudocysts.
- To evaluate the efficacy of a flanged self-expanding covered nitinol stent for cystogastrostomy.
- To establish a less invasive treatment option for pancreatic pseudocysts in children.
Main Methods:
- Retrospective review of six children undergoing image-guided cystogastrostomy at two pediatric hospitals.
- Percutaneous access to the stomach was established via existing or newly formed tracts.
- Combined ultrasound, fluoroscopic, or cone-beam CT guidance was used for stent deployment.
Main Results:
- 100% technical success rate in all six pediatric patients.
- Complete pseudocyst resolution in five children; one had a small residual cyst.
- No complications were reported during or after the procedure.
- Resolution of pseudocyst-related symptoms in all treated children.
Conclusions:
- Image-guided cystogastrostomy with a nitinol stent is a successful and safe method for draining pancreatic pseudocysts in children.
- This technique offers a viable alternative to surgery, especially when endoscopic ultrasound is unavailable.
- The study demonstrates excellent outcomes with no adverse events in a small cohort.
Background:
Endoscopic ultrasound is seldom available at paediatric centres; therefore drainage of pancreatic pseudocysts in children has traditionally been achieved by surgery.
Objective:
This study assessed the feasibility and safety of performing image-guided internal drainage of pancreatic pseudocysts with a flanged self-expanding covered nitinol pancreatic pseudocyst drainage stent.
Materials And Methods:
We conducted a retrospective case note review of children undergoing image-guided cystogastrostomy at two paediatric hospitals. Percutaneous access to the stomach was achieved via an existing gastrostomy tract or image-guided formation of a new tract. Under combined ultrasound, fluoroscopic or cone-beam CT guidance the pancreatic pseudocysts were punctured through the posterior wall of the stomach. A self-expanding covered nitinol stent was deployed to create a cystogastrostomy opening.
Results:
Image-guided cystogastrostomy was performed in 6 children (4 male; median age 6 years, range 46 months to 15 years; median weight 18 kg, range 13.8-47 kg). Two children had prior failed attempts at surgical or endoscopic drainage. Median maximum cyst diameter was 11.5 cm (range 4.7-15.5 cm) pre-procedure. Technical success was 100%. There were no complications. There was complete pseudocyst resolution in five children and a small (2.1-cm) residual pseudocyst in one. Pseudocyst-related symptoms resolved in all children.
Conclusion:
Pancreatic pseudocyst drainage can be successfully performed in children by image-guided placement of a cystogastrostomy stent. In this cohort of six children there were no complications.
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