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Endoscopic ultrasound-guided pancreatic pseudocyst drainage in pediatric patients
Asma Yaseen1, Javeria Salman1, Shanil Kadir2
1Gastroenterology, Sindh Institute of Advanced Endoscopy and Gastroenterology, Karachi 75000, Sindh, Pakistan.
Insights
Endoscopic ultrasound (EUS)-guided drainage is a safe and effective treatment for pediatric pancreatic pseudocysts (PPCs). This minimally invasive approach offers high success rates with no major complications in children.
Area of Science:
- Gastroenterology
- Pediatric Surgery
- Medical Imaging
Background:
- Pancreatic pseudocysts (PPCs) are fluid collections following acute pancreatitis.
- Management options include surgery, percutaneous drainage, and endoscopic approaches.
- Endoscopic ultrasound (EUS)-guided drainage is effective in adults but understudied in children.
Purpose of the Study:
- To evaluate the safety and efficacy of EUS-guided pancreatic pseudocyst drainage in pediatric patients.
- To assess technical and clinical outcomes in children over 10 years old.
Main Methods:
- Retrospective review of pediatric patients (<18 years) undergoing EUS-guided PPC drainage (2015-2024).
- Included 21 symptomatic patients who underwent the procedure.
- Effectiveness assessed by technical success and symptom resolution.
Main Results:
- Mean age was 13.8 years; 52.4% were male.
- Technical and clinical success achieved in all 21 patients.
- No major complications reported; one recurrence required repeat drainage.
Conclusions:
- EUS-guided PPC drainage is safe and effective in the pediatric population.
- It is a preferred alternative to conventional techniques for pediatric pancreatic pseudocysts.
- Procedure should be performed by experienced endoscopists under general anesthesia with pediatric anesthetists.
Background:
Pancreatic pseudocyst (PPC) is a well-encapsulated peri-pancreatic fluid collection that occurs at least 4 weeks after acute pancreatitis. The prevalence of PPC is 8%-41% among patients with a history of pancreatitis. Management includes conventional surgery and percutaneous radiological or endoscopic approaches. Endoscopic ultrasound (EUS)-guided drainage of PPC appears to be a safe and less invasive treatment option. Its efficacy is well established in the adult population. However, data regarding its usage in the pediatric population are limited.
Aim:
To determine the safety and efficacy of EUS-guided PPC drainage in children over 10 years.
Methods:
A retrospective review was conducted of pediatric patients (aged < 18 years) who were referred for EUS-guided PPC drainage between 2015 and 2024. Twenty-eight patients were identified who had been referred to our department for EUS-guided PPC drainage, including 21 patients with symptoms who underwent the procedure. Effectiveness was assessed based on technical success and clinical resolution of symptoms.
Results:
The mean age was 13.81 ± 3.25 years (range: 6-18 years) with 52.4% males. The locations of the PPCs were distributed along the pancreatic body (38.1%) and head/neck regions (38.1%). EUS-guided drainage was performed under general anesthesia. Complete aspiration without stent placement was performed in 11 patients (52.4%) with an average PPC size of 4.3 cm × 3.9 cm. Two double-pigtail plastic stents were required in 9 patients (47.6%) with a mean size of 8.4 cm × 8.0 cm. Lumen-apposing metal stents were required in 1 patient. Technical and clinical successes were achieved in all cases. One patient (4.8%) experienced recurrence that required repeat drainage. No major complications were observed.
Conclusion:
EUS-guided PPC drainage was a safe and effective procedure for our pediatric population and should be preferred over conventional techniques, performed by experienced endoscopists under general anesthesia by pediatric anesthetists.
