Endoscopic ultrasound‐guided drainage of pancreatic fluid collections is safe to perform in children: A comparison of two endoscopic approaches

OBJECTIVES: Pancreatic fluid collections (PFCs), either pseudocysts or walled-off necrosis, are a significant cause of morbidity in pediatric patients with acute pancreatitis, leading to pain, obstruction, or infection. Endoscopic ultrasound (EUS)-guided drainage of symptomatic PFCs is the recommended therapy in adult patients and is accomplished using either lumen-apposed metal stents (LAMS) or double pigtail plastic stents (DPPS). Their comparative outcomes in children remain unstudied. METHODS: We performed a retrospective case series of all EUS-guided drainage of symptomatic PFCs among pediatric patients (<21 years) at a freestanding children's hospital over 12 years. We recorded patient demographics, procedural details, and PFC classifications, and summarized these using descriptive statistics. Outcomes included anesthesia time, intra-procedural radiation exposure, time to enteral feeding, stent dwell time, length of stay, and adverse events. RESULTS: Twenty-five unique patients underwent 27 total procedures with attempted transluminal stent placement. Clinical success was achieved in 96.3%. The median age was 10 years (interquartile range [IQR] 5-19), with a median weight of 28.7 kg (21.9-45.4). Of those who underwent stent placement, asparaginase-induced pancreatitis was the leading cause of PFCs (56%), followed by trauma (30%). Among the attempted stent placements, 9/27 (33%) were DPPS and 18/27 (67%) were LAMS. Eighty-one percent were placed trans-gastrically. Patients in the LAMS group had shorter anesthesia time when adjusting for concurrent procedures (p = 0.03) and lower intra-procedural radiation exposure (p = 0.01). Five total adverse events occurred, with no difference between groups (p = 0.27). CONCLUSION: Endoscopic drainage is a safe and effective strategy for the management of symptomatic pediatric PFCs, with high clinical success for both DPPS and LAMS approaches. Further studies are needed to better understand rates of adverse events.