Endoscopic ultrasound-guided cystogastrostomy in young paediatric patients: a retrospective analysis and systematic review of safety and efficacy

Objective To evaluate the feasibility, safety and efficacy of endoscopic ultrasound-guided cystogastrostomy (EUS-CG) for pancreatic fluid collections (PFCs) in children under 12 years and to compare outcomes between plastic stents and lumen-apposing metal stents (LAMS). Method A retrospective multicentre cohort study was conducted in four tertiary centres (2019–2025) including children <12 years with symptomatic pseudocysts or walled-off necrosis undergoing EUS-CG. Demographics, cyst characteristics, procedural details and ≥6-month follow-up were analysed. Primary outcomes were technical and clinical success; secondary outcomes included procedure duration, hospital stay, complications, recurrence and associations with stent type. A systematic review of paediatric EUS-CG studies (11 studies; n=98) was performed following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020, with study quality assessed using Joanna Briggs Institute checklists. Results Eighteen children were enrolled (mean age 7.8 years); 17 underwent effective EUS-CG (12 plastic stents, 5 LAMS). Technical success was 100% (17/17) and clinical success 94.1% (16/17). Mean cyst size was 8.0 cm, mainly in the pancreatic body/tail; aetiologies included trauma (44%) and post-chemotherapy pancreatitis (28%). Mean procedure time was 19 min with plastic stents vs 10 min with LAMS. Two complications (11.1%) occurred, both in the plastic stent group (mild pancreatitis, intraperitoneal leakage), managed conservatively. No bleeding, perforation, infection, stent migration, recurrence or procedure-related mortality was observed. Across 11 paediatric studies, technical and clinical success ranged from 56% to 100% and 65% to 100%, respectively, with pooled recurrence ≈6%. Conclusion EUS-CG is a safe, feasible and highly effective treatment for PFCs in children under 12 years. LAMS achieve comparable success with shorter procedure times and potentially fewer complications than plastic stents. Larger prospective, cost-effectiveness and age/size-stratified studies are needed to refine paediatric EUS-CG protocols.