Endoscopic Management of Pancreatic Fluid Collections in Children

Abstract

The incidence of acute pancreatitis in children has increased over the last few decades. The development of pancreatic fluid collection is not uncommon after severe acute pancreatitis, although its natural course in children and adolescents is poorly understood. Asymptomatic fluid collections can be safely observed without any intervention. However, the presence of clinically significant symptoms warrants the drainage of these fluid collections. Endoscopic management of pancreatic fluid collection is safe and effective in adults. The use of endoscopic ultrasound (EUS)-guided procedure has improved the efficacy and safety of drainage of pancreatic fluid collections, which have not been well studied in pediatric populations, barring a scant volume of small case series. Excellent results of EUS-guided drainage in adult patients also need to be verified in children and adolescents. Endo-prostheses used to drain pancreatic fluid collections include plastic and metal stents. Metal stents have wider lumens and become clogged less often than plastic stents. Fully covered metal stents specifically designed for pancreatic fluid collection are available, and initial studies have shown encouraging results in adult patients. The future of endoscopic management of pancreatic fluid collection in children appears promising. Prospective studies with larger sample sizes are required to establish their definitive role in the pediatric age group.

A Practical Approach to Management of Acute Pancreatitis: Similarities and Dissimilarities of Disease in Children and Adults

“…For children in whom necrotizing pancreatitis develops and results in a persistent collection, placement of LAMS followed by necrosectomy to clear necrotic debris from the cavity is typically performed. Expertise and experience in therapeutic EUS are more limited in pediatric endoscopy, yet EUS-guided drainage is increasingly performed and reported in children with pancreatic fluid/necrotic collections, with favorable outcomes similar to those reported for adults [48,[50][51][52]. Studies comparing plastic stents versus LAMS are needed for simple and complex pancreatic fluid collections.…”

Intentional internal drainage tube method for nonlocalized persistent pancreatic leakage: a case report

“…After removal of this tube, the fistula in the jejunal wall served as an internal drainage route to transfer pancreatic deposits into the intestinal lumen. Once a mature internal drainage route is generated, relapse or complications should be rare, as has been reported with endoscopic and/or surgical approaches for internal drainage [ 2 , 5 , 12 ]. In fact, our patient has recovered uneventfully for over 5 years.…”

Outcome of radiological interventions in pediatric gastrointestinal diseases: A large tertiary center experience

“…In our study, the PFCs not amenable to endoscopic drainage were managed with percutaneous drainage. Although endoscopic drainage of PFCs is gaining momentum, it may not be feasible in all the cases . The size of endoscopic ultrasound scope may be disproportionate, with a risk of airway compression in small children .…”

“…The size of endoscopic ultrasound scope may be disproportionate, with a risk of airway compression in small children . In addition, some fluid collections are distantly placed from the gastric wall rendering them unsuitable for endoscopic drainage . Percutaneous drainage has equal efficacy to endoscopic drainage for pancreatic pseudocysts.…”