Pediatr Gastroenterol Hepatol Nutr.  2020 Jan;23(1):105-109. 10.5223/pghn.2020.23.1.105.

Endoscopic Management of Large Peripancreatic Fluid Collections in Two Pediatric Patients by Endoscopic Ultrasound-guided Transmural Drainage

• Walsh LT
• Groff A
• Mathew A
• Moyer MT

• KMID: 2467899
• DOI: http://doi.org/10.5223/pghn.2020.23.1.105

Abstract

The incidence of acute pancreatitis (AP) has increased in the pediatric population over the past few decades and it stands to follow that the complications of severe AP, including symptomatic pancreatic fluid collections (PFCs) will increase as well. In adults, the therapeutic options for this situation have undergone a dramatic evolution from mainly surgical approaches to less invasive endoscopic approaches, mainly endoscopic ultrasound-guided transmural drainage (EUS-TD) followed be direct endoscopic necrosectomy if needed. This has proven safe and effective in adults; however, this approach has not been well studied or reported in pediatric populations. Here we demonstrate that EUS-TD seems to offer a safe, efficacious and minimally invasive approach to the management of large PFCs in pediatric patients by reviewing two representative cases at our institution.

Keyword

Acute pancreatic fluid collection; Endoscopic ultrasound-guided transmural drainage

MeSH Terms

Adult
Drainage*
Humans
Incidence
Pancreatitis

Figure

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  Fig. 1 (A) T2-weighted magnetic resonance imaging (MRI) showing an acute peripancreatic fluid collection measuring 9.8×7.2×10.2 cm (arrow) prior to endoscopic ultrasound-guided transmural drainage. (B) Follow-up MRI at 5 months showing resolution of the pancreatic fluid collection.

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  Fig. 2 (A) T2-weighted magnetic resonance imaging (MRI) showing an acute pancreatic fluid collection measuring 10.8×6.6×10.4 cm (arrow) prior to endoscopic ultrasound-guided transmural drainage. (B) Repeat MRI at four weeks showing resolution of the pancreatic fluid collection.

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  Fig. 3 Endoscopic image showing deployment of an AXIOS stent for endoscopic ultrasound-guided transmural drainage.

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