Pancreatic pseudocyst drainage in children by image-guided cystogastrostomy and stent insertion

Premal A Patel,Derek J Roebuck,Craig Gibson,Sam Stuart,Paolo De Coppi,Kishore S Minhas

doi:10.1007/s00247-019-04471-9

Abstract

BackgroundEndoscopic ultrasound is seldom available at paediatric centres; therefore drainage of pancreatic pseudocysts in children has traditionally been achieved by surgery.ObjectiveThis study assessed the feasibility and safety of performing image-guided internal drainage of pancreatic pseudocysts with a flanged self-expanding covered nitinol pancreatic pseudocyst drainage stent.Materials and methodsWe conducted a retrospective case note review of children undergoing image-guided cystogastrostomy at two paediatric hospitals. Percutaneous access to the stomach was achieved via an existing gastrostomy tract or image-guided formation of a new tract. Under combined ultrasound, fluoroscopic or cone-beam CT guidance the pancreatic pseudocysts were punctured through the posterior wall of the stomach. A self-expanding covered nitinol stent was deployed to create a cystogastrostomy opening.ResultsImage-guided cystogastrostomy was performed in 6 children (4 male; median age 6 years, range 46 months to 15 years; median weight 18 kg, range 13.8–47 kg). Two children had prior failed attempts at surgical or endoscopic drainage. Median maximum cyst diameter was 11.5 cm (range 4.7–15.5 cm) pre-procedure. Technical success was 100%. There were no complications. There was complete pseudocyst resolution in five children and a small (2.1-cm) residual pseudocyst in one. Pseudocyst-related symptoms resolved in all children.ConclusionPancreatic pseudocyst drainage can be successfully performed in children by image-guided placement of a cystogastrostomy stent. In this cohort of six children there were no complications.

Highlights

Pancreatic pseudocysts are collections of pancreatic secretions that are lined by fibrous tissues and might contain necrotic debris or blood
Pseudocyst formation is a well-recognised complication of acute pancreatitis, chronic pancreatitis and pancreatic trauma
We identified children by conducting searches of prospectively maintained interventional radiology procedures databases

Summary

Introduction

Pancreatic pseudocysts are collections of pancreatic secretions that are lined by fibrous tissues and might contain necrotic debris or blood. Pseudocyst formation is a well-recognised complication of acute pancreatitis, chronic pancreatitis and pancreatic trauma. Most pancreatic pseudocysts in children resolve spontaneously following conservative management of bowel rest, supportive nutrition and analgesia [3]. Pseudocysts that become symptomatic, persist for 6 weeks or more, or continue to increase in size, especially beyond 6 cm, usually require therapeutic intervention [3, 4]. For collections secondary to trauma, intervention is considered if the symptoms or collection persist for a week after withholding enteral nutrition [5]. Pancreatic pseudocysts can be managed by surgical, percutaneous or endoscopic drainage [1]. In. Endoscopic ultrasound is seldom available at paediatric centres; drainage of pancreatic pseudocysts in children has traditionally been achieved by surgery

Methods

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Discussion

Conclusion