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Endoscopic cystogastrostomy: Still a viable option in children with symptomatic pancreatic fluid collection
Ujjal Poddar1, Surender Kumar Yachha1, Vijai Datta Upadhyaya2
1Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
Endoscopic cystogastrostomy is a safe and effective treatment for pediatric pancreatic fluid collections (PFCs). This procedure shows minimal recurrence and acceptable complications, making it a preferred option for children.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Interventions
- Pancreatic Diseases
Background:
- Pancreatic fluid collections (PFCs) management in children lacks extensive literature.
- Endoscopic transmural drainage is the standard for adults, but its pediatric application is less studied.
Purpose of the Study:
- To evaluate the efficacy and safety of endoscopic cystogastrostomy for draining PFCs in pediatric patients.
- To analyze outcomes including technical success, complications, and recurrence rates.
Main Methods:
- Retrospective analysis of prospectively collected data from 31 children (<18 years) undergoing endoscopic cystogastrostomy.
- Procedures performed using standard techniques with adult duodenoscopes between June 2013 and December 2017.
Main Results:
- Successful drainage in 29 of 31 (93.5%) children with no mortality.
- Adverse events occurred in 12.9% (infections, bleeding, pneumoperitoneum), all resolving spontaneously.
- 90% had no pseudocyst recurrence over a median follow-up of 26 months.
Conclusions:
- Endoscopic cystogastrostomy is a safe and effective minimally invasive option for draining bulging PFCs in children.
- The procedure demonstrates acceptable morbidity and low recurrence rates.
- It may be the preferred drainage method for PFCs in the pediatric population.
Background/Objectives:
Endoscopic transmural drainage is the preferred method of drainage of pancreatic fluid collections (PFCs) in adults; however, there is scant literature in children. We analyzed our experience of 33 endoscopic cystogastrostomies done in 29 children to find its efficacy and safety.
Methods:
We retrospectively analyzed the prospectively collected database of 31 consecutive children (<18 years) who underwent endoscopic cystogastrostomy from June 2013 to December 2017. The procedure was done using the standard technique with an adult duodenoscope. Data related to clinical details, technical success, complications and follow-up were collected.
Results:
The median age was 14 (3-17) years (22 males). Indications were early satiety in 28 (90%), vomiting in 15 (48%), and duodenal obstruction and infected pseudocyst in 2 children each. Etiology includes acute pancreatitis 22, post-traumatic 4 and chronic pancreatitis 5. The procedure was successful in 29 of 31 (93.5%) children with no mortality. Adverse events happened in four cases (12.9%); two infections, another with bleeding and another with pneumoperitonium, both of which resolved spontaneously. Incidents (minor bleeding) were noted in 6 (19%). Stents were removed in 26 (90%) after 12 (7-20) weeks and got spontaneously migrated out in 3 (10%) cases. Over a median follow-up of 26 (5-48) months, 26 (90%) had no recurrence of pseudocyst and 3 (10%) had recurrence of a small, asymptomatic pseudocyst.
Conclusions:
Endoscopic cystogastrostomy is a safe and effective method of draining bulging PFCs in children. The procedure carries acceptable morbidity with minimal recurrence. In younger children it may be the preferred method of drainage of PFCs.
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