Efficacy of endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population.
BACKGROUND
While pancreatitis is uncommon in children, pseudocyst development can be a serious complication. Endoscopic drainage of pseudocysts is well established in adults. However, there are limited data regarding this procedure in a pediatric population. The objective of this study is to determine the safety and efficacy of endoscopic ultrasound-guided pseudocyst drainage in children.


METHODS
The study group included children (age <18 years) who presented for endoscopic drainage of symptomatic pancreatic pseudocysts in whom endoscopic ultrasound (EUS) was performed. In those cases with EUS guidance, a 19-gauge needle was used to access the pseudocyst and place a guidewire under fluoroscopic visualization. Needle-knife diathermy and balloon dilation of the tract were performed with subsequent placement of double pig-tailed stents for drainage.


RESULTS
Ten children with mean age of 11.8 years (range 4-17 years) were analyzed for pancreatic pseudocysts due to biliary pancreatitis (n = 4), trauma (n = 2), familial pancreatitis (n = 1), idiopathic pancreatitis (n = 2), and pancreas divisum (n = 1). In eight cases, EUS-guided puncture and stent placement was successful. In the remaining two cases, aspiration of cyst fluid until complete collapse was adequate. As experience increased with EUS examination in children, the therapeutic EUS scope alone was used in 50% of cases for the entire procedure. In all ten cases, successful transgastric endoscopic drainage of pseudocysts was achieved.


CONCLUSIONS
Endoscopic drainage of symptomatic pancreatic pseudocysts can be achieved safely in children. EUS guidance facilitates optimal site of puncture as well as placement of transmural stents.
Jazrawi
Saad F
SF
Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 9083, Dallas, TX 75390-9151, USA.
Barth
Bradley A
BA
Sreenarasimhaiah
Jayaprakash
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D019160:Endosonography / Q000295:instrumentation; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation; D006801:Humans; D008297:Male; D010192:Pancreatic Pseudocyst / Q000000981:diagnostic imaging / Q000601:surgery*; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000601:surgery; D015607:Stents; D016896:Treatment Outcome