Endoscopic ultrasound guided cystogastrostomy in pediatric patients with pancreatic pseudo-cyst using plastic stents- tertiary care experience in Pakistan

Background: Pancreatic pseudocyst is a common complication in both acute and chronic pancreatitis in children. Endoscopic drainage of pancreatic pseudocyst is the first line treatment in adults but there is very limitated published work on safety and long-term efficacy of endoscopic ultrasound guided drainage of pancreatic pseudocyst in pediatric population. Objective: In this study, we have shared our experience of endoscopic ultrasound guided cystogastrostomy procedure, using a plastic stent in pediatric population. Methods: A retrospective data analysis of patients <16 years of age with pancreatic pseudo cyst was done from January 2023 - January 2025 at the Department of Pediatric Medicine, Pediatric Gastroenterology division, Lahore General Hospital, Lahore, Pakistan. Descriptive statistics, clinical / technical success and adverse events were assessed. Results: In nineteen patients of <16 years, M: F 13:6, with pancreatic pseudocyst EUS guided cystogastrostomy was done. Mean age was 7.28 (2-16). Technical and clinical success was achieved in all patients. Adverse effects like minor bleed and post cystogastrostomy infection were observed however, no major adverse effects like major bleed, cyst perforation, stent displacement occurred. Patients were followed at a median of 14 months (6-18) and no complications due to plastic stent were seen. Conclusion: Endoscopic guided cystogastrostomy procedure is safe and effective in children with pancreatic pseudocyst; plastic stents can safely be kept in place for an extended period. However, further studies with a larger sample size are needed.