Introduction
Pancreatic pseudocyst (PPC) is a well defined local complication of pancreatitis. It has been reported in 8-41% of patients with history of pancreatitis in children1. In past, surgical technique was treatment of choice for PPC drainage2, however with advancements in endoscopic interventions, endoscopic ultrasound (EUS) guided PPC drainage is preferred in present era. Limited literature is available for EUS guided PPC drainage in pediatrics, owing to structure of echo-endoscope due to its rigid tip3, need of anesthesia and endoscopic skills. This study is one of the largest retrospective data4 in which we have shared experience of last 10 years for EUS guided PPC drainage from a tertiary care center of Pakistan.
Aims & Methods
This study aimed to evaluate the safety of EUS-guided PPC drainage in a large paediatric cohort (≤18 years) in Karachi, Pakistan, and assess technical and clinical success.
We retrospectively reviewed the charts of patients ≤18 years who underwent EUS-guided PPC drainage from 2015 to 2024 at the Sindh Institute of Advanced Gastroenterology, a tertiary care centre in Karachi, Pakistan. Data collected include patient demographics, aetiology of pancreatitis, PPC characteristics, procedural details, and outcomes. Technical success was defined as successful stent placement across the cyst gastrostomy. Clinical success included PPC resolution and symptom improvement.
Results
28 patients were referred for EUS-guided PPC drainage, 7 patients had no symptoms when presented, so 21 patients underwent EUS-guided PPC drainage. All patients were given general anesthesia by a pediatric anesthetist, and the airway was secured by endotracheal intubation to avoid the risk of aspiration. out of 21 patients,11 were male, with ages ranging from 6 to 18 years (Mean age 14.00± 3.25 years). 11 patients underwent EUS-guided complete aspiration of pseudocyst, with average pseudocyst size of 4.27 X3.93 cm, ranged from 2X1.2cm to 6.7 x5.6 cm. 10 patients underwent EUS-guided pseudocyst drainage via stent placement. The average size of PPC in this group was 8.39 X 8.02 cm, ranged from 6 X5 cm to 14X10cm. 8 pseudocysts were located along the pancreatic body region, 8 were located along the head and neck, and 5 were located near the tail region. Two Double pig tail plastic stents (DPPS) of 7fr 4cm were placed in 9 patients and 7fr 6cm in one patient transmurally into the cyst-gastrostomy tract, whereas LAMS hot axios 10x20 mm was placed in one patient only. One of the patients had a recurrence of pseudocyst with symptoms after 3 months, hence needing repeat pseudocyst drainage. One patient had displacement of DPPS. None of the patients developed major complications.
Conclusion
Endoscopy guided pancreatic pseudocyst drainage is safe and effective in pediatric population, however this procedure should be done by trained and experienced endoscopists under general anesthesia by pediatric anesthetist and EUS guided technique should be preferred over conventional technique of PPC drainage.
References
1.Park, A., Latif, S.U., Shah, A.U., Tian, J., Werlin, S., Hsiao, A., Pashankar, D., Bhandari, V., Nagar, A. and Husain, S.Z. (2009), Changing Referral Trends of Acute Pancreatitis in Children: A 12-year Single-center Analysis. Journal of Pediatric Gastroenterology and Nutrition, 49: 316-322. https://doi.org/10.1097/MPG.0b013e31818d7db3
2.Szakó L, Mátrai P, Hegyi P, Pécsi D, Gyöngyi Z, Csupor D, Bajor J, Erőss B, Mikó A, Szakács Z, Dobszai D. Endoscopic and surgical drainage for pancreatic fluid collections are better than percutaneous drainage: Meta-analysis. Pancreatology. 2020 Jan 1;20(1):132-41
3.Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, Spaander M, Hassan C, Tzvinikos C, Ijsselstijn H, Viala J. Paediatric gastrointestinal endoscopy: European society for paediatric gastroenterology hepatology and nutrition and European society of gastrointestinal endoscopy guidelines. Journal of pediatric gastroenterology and nutrition. 2017 Jan 1;64(1):133-53
4.Nabi Z, Talukdar R, Lakhtakia S, Reddy DN. Outcomes of Endoscopic Drainage in Children with Pancreatic Fluid Collections: A Systematic Review and Meta-Analysis. Pediatr Gastroenterol Hepatol Nutr. 2022 May;25(3):251-262. doi: 10.5223/pghn.2022.25.3.251. Epub 2022 May 9. PMID: 35611379; PMCID: PMC9110851.