Endoscopic Treatment of Walled-off Necrosis in Children: Clinical Experience and Treatment Outcomes.

Abstract

Data on the endoscopic treatment outcomes for walled-off necrosis (WON) in children are limited. The aim of the present study was to evaluate the efficacy and safety of endoscopic approach for the treatment of WON in children. A retrospective study was conducted of all children with symptomatic WON treated endoscopically over 6 years. Treatment consisted of endoscopic ultrasound-guided transmural drainage using either a lumen-apposing metal stent or multiple 7Fr double pigtail plastic stents with or without percutaneous drainage. Main outcome measures were technical success, treatment success, recurrence, reinterventions, and adverse events. Six children (5 girls, median age 12 years) underwent endoscopic ultrasound-guided WON drainage by creation of a single transmural tract in 5 patients and multiple transmural tracts in 1. Stents placed were plastic in 5 patients and lumen-apposing metal stent in 1. One patient underwent concomitant percutaneous drainage. Treatment success was achieved in all of the 6 patients (100%) following a single intervention in 4 patients and 2 interventions in 2. No procedure-related adverse events were encountered. At 8-week follow-up, the transmural stents were retrieved in all but 1 patient who had a disconnected pancreatic duct. At a median follow-up of 781 days (interquartile range 336-869 days), no WON or symptom recurrence was encountered in any patient. Endoscopic treatment is effective, safe, and when available should be the first-line modality for the management of WON in children.