Endoscopic Drainage of Pancreatic Fluid Collections - Long Term Outcomes in Children

Abstract

Background and Objective

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

The data of all children (<18 years) with PFC who underwent EUS-drainage with plastic stents was analysed retrospectively. Technical feasibility, clinical efficacy and adverse events (AE) were analysed.

Results

Thirty one children (boys-22, girls-8) with PFC underwent EUS drainage (January 2013 to June 2016). Mean age of children was 13±3.41 (5-17years). Majority of children had idiopathic pancreatitis (23), followed by trauma related (6) and gall stone related (1). Of 30 PFCs–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 due to hematemesis (1). Imaging revealed disconnected pancreatic duct in 9, ductal leak in 2 and stricture in one child. Cysto-gastric 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. Cysto-gastric plastic stents can be left safely for long-term. However, more studies with larger sample size are required.

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