Endoscopic ultrasound-guided pancreatic pseudocyst drainage in pediatric patients

BACKGROUND: Pancreatic pseudocyst (PPC) is a well-encapsulated peri-pancreatic fluid collection that occurs at least 4 weeks after acute pancreatitis. The prevalence of PPC is 8%-41% among patients with a history of pancreatitis. Management includes conventional surgery and percutaneous radiological or endoscopic approaches. Endoscopic ultrasound (EUS)-guided drainage of PPC appears to be a safe and less invasive treatment option. Its efficacy is well established in the adult population. However, data regarding its usage in the pediatric population are limited. AIM: To determine the safety and efficacy of EUS-guided PPC drainage in children over 10 years. METHODS: A retrospective review was conducted of pediatric patients (aged < 18 years) who were referred for EUS-guided PPC drainage between 2015 and 2024. Twenty-eight patients were identified who had been referred to our department for EUS-guided PPC drainage, including 21 patients with symptoms who underwent the procedure. Effectiveness was assessed based on technical success and clinical resolution of symptoms. RESULTS: The mean age was 13.81 ± 3.25 years (range: 6-18 years) with 52.4% males. The locations of the PPCs were distributed along the pancreatic body (38.1%) and head/neck regions (38.1%). EUS-guided drainage was performed under general anesthesia. Complete aspiration without stent placement was performed in 11 patients (52.4%) with an average PPC size of 4.3 cm × 3.9 cm. Two double-pigtail plastic stents were required in 9 patients (47.6%) with a mean size of 8.4 cm × 8.0 cm. Lumen-apposing metal stents were required in 1 patient. Technical and clinical successes were achieved in all cases. One patient (4.8%) experienced recurrence that required repeat drainage. No major complications were observed. CONCLUSION: EUS-guided PPC drainage was a safe and effective procedure for our pediatric population and should be preferred over conventional techniques, performed by experienced endoscopists under general anesthesia by pediatric anesthetists.