Endoscopic Ultrasound Drainage Research Articles

Endoscopic drainage of malignant distal biliary obstruction. Will ERCP no longer be necessary?

We read with interest the Editorial by Vila et al. on the paradigm shift for endoscopic biliary drainage of malignant distal biliary obstruction (MDBO) which places Endoscopic Ultrasound (EUS) drainage as the first option instead of traditional ERCP drainage. The modern biliary endoscopist must have the duodenoscope in one hand and the therapeutic echoendoscope in the other. ERCP training alone is no longer appropriate because the goal is to drain the obstruction during a single session. That is why in more and more centers the patient signs a single consent for endoscopic biliary drainage, whether by ERCP, EUS or combined. Should EUS drainage be used first for MDBO without attempting ERCP? A possible protocol for endoscopic drainage of MDBO could be to start with the duodenoscope for ERCP. If the papilla of Vater is accessible, try cannulation considering the ESGE criteria for a difficult cannulation: more than 5 contacts with the papilla; more than 5 minutes spent attempting to cannulate following visualization of the papilla; more than one unintended pancreatic duct cannulation or opacification. If biliary cannulation is not achieved, immediately switch to EUS drainage during the same session. Occasionally, the double guidewire technique or even transpancreatic biliary sphincterotomy could be used, but not needle-knife precut.

Self-Expandable Metal Stent (SEMS) Versus Lumen-Apposing Metal Stent (LAMS) for Drainage of Pancreatic Fluid Collections: A Randomized Clinical Trial.

Background and aim Endoscopic ultrasound (EUS)-guided drainage is the gold standard approach for the treatment of encapsulated pancreatic collections (EPCs) including pseudocyst and walled-off pancreatic necrosis (WON), and is associated with an equivalent clinical efficacy to surgical drainage with fewer complications and less morbidity. Drainagemay be achieved via several types of stents including a fully covered self-expandable metallic stent (SEMS) and lumen-apposing metal stent (LAMS). However, to date there have been no randomized trials to compare these devices. This study aimed to compare the efficacy and safety of the SEMS versus LAMS for EUS-guided drainage of EPCs. Methods A phase IIB randomized trial was designed to compare the SEMS versus LAMS for the treatment of EPCs. Technical success, clinical success, adverse events (AEs), and procedure time were evaluated. A sample size of 42 patients was determined. Results There was no difference between the two groups in technical (LAMS 80.95% vs 100% SEMS, p=0.107), clinical (LAMS 85.71% vs 95.24% SEMS, p=0.606) or radiological success (LAMS 92.86% vs 83.33% SEMS, p=0.613). There was no difference in AEs including stent migration rate and mortality. The procedure time was longer in the LAMS group (mean time 43.81 min versus 24.43 min, p=0.001). There was also a difference in the number of intra-procedure complications (5 LAMS vs 0 SEMS, p=0.048). Conclusion SEMS and LAMS have similar technical, clinical, and radiological success as well as AEs. However, SEMS has a shorter procedure time and fewer intra-procedure complications compared to non-electrocautery-enhanced LAMS in this phase IIB randomized controlled trial (RCT). The choice of the type of stent used for EUS drainage of EPCs should consider device availability, costs, and personal and local experience.

Endoscopic ultrasound drainage of pancreatic fluid collections: do we know enough about the best approach?

Pancreatic fluid collection often occurs as a local complication of acute pancreatitis, and drainage is indicated in symptomatic patients. The drainage may be surgical, percutaneous, or endoscopic ultrasound (EUS) guided. In symptomatic collections older than 4 weeks and localized in the upper abdomen, EUS-guided drainage is the first choice of treatment. Lumen-apposing metal stents are useful in cases of walled-off necrosis, facilitating access to the cavity; however, they do not reduce the number of necrosectomy sessions required. In most pancreatic pseudocysts requiring drainage, plastic stents remain the first choice of treatment. This review aimed to summarize the principles and techniques of step-up therapy of pancreatic fluid collections, including preprocedural and postprocedural assessment and practical approaches of drainage and necrosectomy, making available evidence more accessible to endoscopists aiming to train for this procedure. Successful and safe EUS drainage connotes early recognition and treatment of complications and the presence of a multidisciplinary team for optimal patient management. However, the best time for necrosectomy, modality of drainage method (lumen-apposing metal stents or plastic stents), and duration of antibiotherapy are still under evaluation.

Systematic Review and Meta-analysis of Endoscopic Ultrasound Drainage for the Management of Fluid Collections after Pancreas Surgery

Systematic Review and Meta-analysis of Endoscopic Ultrasound Drainage for the Management of Fluid Collections after Pancreas Surgery

Efficacy and safety of endoscopic ultrasound guided drainage of pseudocysts and walled-off necrosis after failure of percutaneous drainage.

Endoscopic Ultrasound (EUS) represents the gold standard for initial drainage of pancreatic fluid collections (PFC) due to various etiologies. However, data concerning salvage EUS drainage after initial percutaneous drainage are limited. The purpose of our study was to evaluate the clinical outcomes and safety of EUS-guided drainage of pancreatic collections after failure of percutaneous drainage. This retrospective study was conducted in a single, tertiary university center from August 2013 to January 2020. Indication was pancreatic collection after acute pancreatitis with PFC requiring EUS-guided drainage after failure of percutaneous drainage. Twenty-two patients with PFC after acute pancreatitis were included (mean age 64.1 ± 11.3years) of which 4/22 (18.2%) had pancreatic pseudocyst and 18/22 (81.8%) presented with a walled-off necrosis. Seventy-six interventions were performed among the 22 patients. Lumen-Apposing Metal Stent (LAMS) were used in 5/22 (22.7%) and double pigtail plastic stents in 17/22 (77.3%) of interventions with a median number intervention of 3 per patient (range 1 to 7). Technical success rate was 98.7% (75/76) with an overall clinical success of 81.8% (18/22). Procedure related adverse events rate was 9.1% (2/22) including one bleeding and one pancreatic fistula. Two non-procedure related deaths were observed. EUS-guided pancreatic collection drainage is clinically effective and safe after clinical/technical failure of radiological percutaneous management.

Management of infected post-pancreatic resection fluid collections under endoscopic ultrasound guidance using lumen apposing metal stent: A case series and review of the literature.

Backgrounds/AimsPost-operative pancreatic fistulas (POPF) and fluid collections (POPFC) remain significant sources of morbidity and mortality after pancreatic resections. There remains a paucity of literature describing endoscopic ultrasound (EUS) guided drainage of POPFC using a Hot AXIOS™ lumen apposing metal stent (LAMS).MethodsWe conducted a retrospective study, encompassing all consecutive patients with POPFC managed using Hot AXIOS™ LAMS at our institution between January 2017 and December 2019. Primary outcome measures were technical and clinical success. Secondary outcome measures were adverse events and recurrence rates.ResultsFive patients underwent EUS guided drainage using Hot AXIOS™ LAMS during the study period. Mean age of patients was 67.8 ± 2.16 years. The majority (60.0%) of patients were males. Median duration of symptom onset after surgery was 9 days. All patients presented with abdominal pain. Median size of the collection measured on computed tomography was 91 mm. Median interval time between symptom onset and EUS drainage was 30 days. Two patients required percutaneous drainage prior to EUS guided drainage. Technical and clinical success were achieved for all patients. No adverse events were observed. Median duration of follow-up was 90 days. No recurrence of collection occurred during the follow-up period.ConclusionsEUS guided drainage of POPFC using Hot AXIOS™ LAMS is a safe and effective treatment modality with technical and clinical success rates of 100% in our experience.

Endoscopic Ultrasound Drainage of the Gallbladder in Acute Cholecystitis in Patients at High Surgical Risk

The standard treatment for acute cholecystitis is laparoscopic cholecystectomy. Alternative procedures are used for patients at high surgical risk. Percutaneous drainage is widely available. The alternative of transpapillary drainage of the gallbladder via the ductus cysticus has only limited prospects of success. With the widespread use of interventional endoscopic ultrasound and the development of new stent systems, endoscopic ultrasound gallbladder drainage has proven to be a safe and reliable procedure. We retrospectively report on our experiences in 11 consecutive patients with endoscopic ultrasound gallbladder drainage in acute cholecystitis between December 2018 and January 2021. 11 patients with acute cholecystitis with a mean age of 84.5 years (70-95 years) are reported. All patients had severe general comorbidities or advanced abdominal tumours or a combination of these conditions. After interdisciplinary debate, the indication for interventional therapy was made. This was carried out in 9 cases by means of endosonographic drainage alone and in 2 cases by means of percutaneous and two-stage endosonographic drainage. Technical success was achieved in 10 cases (91%), clinical success in 9 cases (82%). In 2 cases there were procedural complications that led to the operation. In the case of high surgical risks, endosonographic drainage of the gall bladder is a safe and definitive therapy. This can be performed alone or in combination with percutaneous drainage. Endoscopic ultrasound drainage is superior to percutaneous drainage alone, due to its lower complication rates and lower rates of necessary follow-up interventions. Therefore, in cases of relatively high surgical risk, endoscopic ultrasound drainage of the gall bladder should be preferred to percutaneous drainage, especially when definitive therapy is required.

S3060 Candida-Associated Gastric Wall Abscess: A Rare Finding

INTRODUCTION: Candida is ubiquitously found throughout the gastrointestinal tract in 30–55% of normal individuals. Suppurative gastritis complicated by gastric abscess is a rare condition marked by purulent inflammation of the gastric wall. Only 500 cases of suppurative gastritis have been reported and of which 5–15% of cases are localized and carries an associated mortality rate of 37–84%. Most gastric abscess are due to a bacterial pathogen and less than 20 published cases are due to a fungal infection. We present a case of gastric ulcer complicated by Candida abscess formation. CASE DESCRIPTION/METHODS: A 48-year-old Caucasian female with end-stage renal disease and ischemic cardiomyopathy presented to the hospital following a cardiac arrest with return of spontaneous circulation. Patient was not on nonsteroidal anti-inflammatory drugs and immunosuppressants. She had no history of H. Pylori infection or alcohol use. On presentation, she was febrile 38.1°C and hypotensive on vasopressors. Abdominal exam was unremarkable. Labs revealed leukocytosis of 21,000/mm3 and negative blood cultures. The CT scan of the abdomen showed a 6.4 × 3.9 × 6.9 cm submucosal hypodense fluid collection with adjacent tract of gas within the wall of the stomach but no gastric perforation. The upper endoscopy revealed a large 5 cm ischemic appearing clean-based ulceration occupying the fundus and proximal body at the greater curvature of the stomach. An endoscopic ultrasound (EUS) confirmed a 5 × 5 cm fluid collection with solid components. 75mL of purulent fluid was aspirated which grew Candida albicans. She was treated with intravenous fluconazole and proton-pump inhibitors with a complete resolution of symptoms and leukocytosis. A repeat upper endoscopy showed healing of the gastric ulcer. The patient remained well 3 months after the hospital discharge. DISCUSSION: Gastric candidiasis may present as ulcer or submucosal tumor-like lesion. Candida-associated gastric ulcer has been reported in both healthy and immunocompromised patients. In our patient , a direct fungal invasion secondary to mucosal breakdown from the large gastric ulcer likely led to gastric abscess formation. This highlights a successful conservative management of a Candida-associated gastric ulcer with abscess via EUS drainage and antifungal treatment. Given its high mortality and nonspecific presentation, its diagnosis requires a high degree of suspicion and early treatment.Figure 1.: A large 5 cm ischemic appearing clean-based ulceration occupying the fundus and proximal body at the greater curvature of the stomach on upper endoscopy.Figure 2.: CT abdomen showing a 6.4 × 3.9 × 6.9 cm submucosal hypodense fluid collection (blue arrow) with adjacent tract of gas within the wall of the stomach but no gastric perforation.

Tu1054 ENDOSCOPIC ULTRASOUND DRAINAGE IS ASSOCIATED WITH REDUCED HOSPITAL STAY IN PATIENTS HOSPITALIZED WITH PANCREATIC PSEUDOCYST

Although endoscopic ultrasound (EUS)-guided pancreatic pseudocyst drainage is increasingly being performed, few small studies have compared the clinical outcomes and cost-effectiveness of EUS drainage with percutaneous and surgical drainage. We designed this study to compare endoscopic, percutaneous and surgical drainage in patients hospitalized with pancreatic pseudocyst.

Endoscopic Ultrasound Drainage Is Associated With Reduced Hospital Stay in Patients Hospitalized With Pancreatic Pseudocyst

Endoscopic Ultrasound Drainage Is Associated With Reduced Hospital Stay in Patients Hospitalized With Pancreatic Pseudocyst

EUS-Guided Transgastric Drainage of Intraabdominal Fluid Collections.

Intraabdominal fluid collections can be a significant cause of morbi-mortality among patients with acute pancreatitis and those who underwent surgery, especially oncological ones. Nowadays, the treatment tends to be minimally invasive, so that the patient's recovery would be shorter and the quality of life higher. EUS (endoscopic ultrasound) has emerged in the last decade to fulfill that demand, alongside percutaneous and surgical drainage in the management of perigastric collections. Objectives: The main objective of this paper is to evaluate the efficacy of EUS guided drainage in terms of techincal and clinical success. Secondary objectives refer to the assessment of complete resolution of intraabdominal collection, presence of infection after drainage, overall survival. Methods: We conducted a prospective study by enrolling 31 patients who were diagnosed using EUS with perigastric intraabdominal fluid collections, from an overall of 788 EUS performed over a period of 2 years. We analyzed their evolution during 6 months after treatment, by regular examinations (ultrasound/endoscopic/computed tomography). All of them were in-patients of Bucharest Clinical Emergency Hospital, either in Endoscopy or in Surgery Departments. Data collected was processed in IBM SPSS Statistics 20. Results: Overall mean age was 51 year and intraabdominal collections average was 109 mm (range 34 250 mm) and was correlated with the method of treatment (p 0.005). Patients underwent different methods for their intraabdominal collections: EUS drainage, CT (computed-tomography)- guided percutaneous drainage, surgical intervention, alone or combined when needed. Overall mortality was 9,3% and was mainly related to the severity of the case and sepsis. Conclusions: We conclude that endoscopic ultrasound can be the first choice for drainage of intraabdominal perigastric fluid collections because it is a safe and effective technique with 100 % technical success, and with over 80 % clinical success assures a better quality of life. For collections with a diameter larger than 127 mm, we can expect however the need of combined treatment, EUS and surgery.

Endoscopic drainage of pancreatic fluid collections: Long‐term outcomes in children

Endoscopic drainage of pancreatic fluid collections (PFC) is the standard of care in adult patients. The literature is limited in children. In the present study, we aim to evaluate the safety and long-term efficacy of endoscopic ultrasound (EUS)-guided drainage of PFC in children. Data of all children (<18 years) with PFC who underwent EUS-guided drainage with plastic stents were analyzed retrospectively for technical feasibility, clinical efficacy and adverse events (AE). Thirty children (boys 22, girls 8) with PFC underwent EUS drainage (January 2013 to June 2016). Mean age of children was 13.07 ± 3.41 years (5-17 years). Majority of children had idiopathic pancreatitis (23), followed by trauma-related (6) and gallstone-related pancreatitis (1). Of 30 PFC, 13 (43.3%) and 17 (56.7%) were classified as pseudocyst and walled-off necrosis, respectively. Median size of PFC was 95 mm (61-175). EUS drainage was successfully completed in 29 children (technical success 96.7%). Clinical success was achieved in 28/30 (93.3%) children. AE included perforation (2), major bleed (1), minor bleed (2), stent migration (4) and readmission as a result of hematemesis (1). Imaging revealed disconnected pancreatic duct in nine, ductal leak in two and stricture in one child. Cystogastric stents were left in situ in children with disconnected duct. At median follow up of 829 days (150-1230), two recurrences of PFC were noticed. EUS-guided drainage using plastic stents is safe and effective in children with PFC. Cystogastric plastic stents can be left safely long term. However, more studies with larger sample sizes are required.

Endoscopic Ultrasound–guided Drainage of Walled‐off Necrosis in Children With Fully Covered Self‐expanding Metal Stents

Endoscopic ultrasound (EUS)-guided drainage with fully covered self-expanding metallic stents (FCSEMS) has been successfully used in adult patients. The utility of FCSEMS in children with walled-off necrosis (WON) is, however, unknown. The aim of present study was to evaluate the feasibility, safety, and efficacy of EUS drainage of WON using FCSEMS in children. We retrospectively evaluated the data of children (18 years or younger) who underwent EUS drainage of WON using FCSEMS at our institution. All FCSEMS were removed between 1 and 3 months. Feasibility, safety, and efficacy were analysed. Twenty-one children (20 boys, mean age 14.9 ± 2.34 years, range 9-18 years) underwent EUS-guided drainage of WON with FCSEMS. The median size of WON was 88 mm (55-148 mm). The median interval between onset of acute pancreatitis and EUS guided drainage was 58 days (range 30-288 days). The technical and clinical success rates were 100% and 95%, respectively. Nasocystic tube was placed in 3 children for lavage. Endoscopic necrosectomy was not required in any of the children. There were no major complications. Minor complications included bleeding (2), stent migration (1), and difficulty in removal of stent (1). After a median follow-up of 360 days (range: 30-1020 days), there was 1 recurrence of WON. EUS drainage of WON using specially designed FCSEMS is safe and efficacious in children. The utility of FCSEMS in children should be further explored and compared with plastic stents.

Endoscopic ultrasound-guided pelvic abscess drainage

Endoscopic ultrasound (EUS)-guided pelvic abscess drainage though uncommon modality for definite treatment of pelvic abscess is an effective method of treatment for pelvic abscess due to its proximity to rectal wall. We performed drainage of pelvic abscess in a 65-year-old male with uncontrolled diabetes, abscess was measured 78 mm × 77 mm, drainage was performed using two 10 Fr pigtail stents, spontaneous drainage of entire abscess cavity was noted, and the patient was discharged on the same day on oral antibiotics with dramatic improvement in pain, fever, and total leukocyte count. EUS drainage has an advantage of being a day-care procedure; as compared to percutaneous drainage, no discomfort of external catheter and limited mobility are experienced by the patient. Other modalities such as conventional ultrasonography-guided per rectal/vaginal drainage have disadvantage that stent cannot be placed.

Endoscopic ultrasound drainage of pancreatic pseudocyst – a case of bleeding controlled with lumen-apposing metal stent and balloon tamponade

Background:Endoscopic ultrasound (EUS) has been widely used as the modality for drainage of pancreatic pseudocyst or walled-off necrosis. We described a case of EUS-guided drainage complicated with bleeding and successfully stopped by lumen-apposing metal stent (LAMS) and balloon tamponade.Case Report:A 49-year-old man presented with acute pancreatitis in April 2015. Follow-up imaging showed a persistent 12 cm pancreatic pseudocyst. EUS-guided drainage of the pseudocyst was performed but complicated with bleeding. LAMS and balloon tamponade were used for drainage and hemostasis. The pseudocyst was successfully drained by EUS-guided LAMS drainage. Reassessment computed tomography scan showed pseudocyst significantly reduced in size.Conclusion:EUS-guided drainage with LAMS is an effective means of pancreatic pseudocyst drainage. LAMS and balloon tamponade can be used for hemostasis in case of bleeding after EUS-guided drainage.

Endoscopic treatment of large pancreatic fluid collections (PFC) using self-expanding metallic stents (SEMS) - a two-center experience.

Background/study aim: During the last several years, endoscopic ultrasound (EUS)-guided pancreatic fluid collections’ (PFC) drainage has evolved into the preferred drainage technique. Recently, self-expanding metallic stents (SEMS) have been used as an alternative to double pigtail stents, with the advantage of providing a larger diameter fistula, thereby decreasing the risk of early obstruction and also allowing for direct endoscopic exploration of the cavity. The aim of this study was to evaluate the technical and clinical success, safety, and outcome of patients undergoing EUS-guided drainage of complex PFC using SEMS. Patients/materials and methods: The study was conducted at two tertiary hospitals from January 2010 to January 2013. All patients with PFC referred for endoscopic drainage were enrolled in a prospective database. The inclusion criteria were: (1) patients with pseudocysts or walled-off necrosis based on the revised Atlanta classification; (2) symptomatic patients with thick PFC; (3) PFC that persisted more than 6 weeks; and (4) large PFC diameter (≥ 9 cm). The exclusion criteria consisted of coagulation disorders, PFC bleeding or infection, and failure-to-inform written consent. Results: A total of 16 patients (9 females, 7 males; mean age 52.6, range 20 – 82) underwent EUS drainage with SEMS. There were 14 cases of pseudocysts and 2 cases of walled-off necrosis. The etiologies of the PFC were mainly gallstones (8 of 16 patients, 50 %) and alcohol (5 of 16 patients, 31 %). Technical success was achieved in 100 % of the cases. All patients had a complete resolution of the PFC. Conclusion: Transmural EUS-guided drainage of complex PFC using SEMS is feasible, appears safe, and is efficacious. However, the exchange of the UC (uncovered)-SEMS for plastic stents is mandatory within 1 week. Future prospective studies, preferably multicenter studies, comparing SEMS versus traditional plastic stents for the drainage of PFC are warranted.

INDICATIONS OF ENDOSCOPIC ULTRASOUND IN THE DIAGNOSIS AND TREATMENT OF GASTROINTESTINAL AND PANCREATICO – BILIARY DISEASES

The gastrointestinal and pancreatico-biliary diseases are very common in Vietnam and lead to severe complications. In the 1980s, Endoscopic Ultrasound (EUS) was invented, and then rapidly EUS has become an useful diagnosis in gastrointestinal and pancreatico-biliary diseases. Most of scientific researches in the word has demonstrated the sensitivity and specificity of EUS in diagnosis for gastrointestinal and pancreatico-biliary diseases. In addition, Endoscopic ultrasound therapy such as: Endoscopic ultrasound - Fine Needle Aspiration (EUS-FNA), Endoscopic ultrasound drainage and Endoscopic ultrasound-guided celiac plexus neurolysis/block were evaluated to have the highest specificity and sensitivity in diagnosis, treatment and follow up gastrointestinal and pancreatico-billiary diseases. Therefore, EUS has an important significance in development and completion of the EUS procedure in Vietnam. This new medical procedure is highly practicable in the gastrointestinal and pancreatico- biliary diagnosis in the early period. The aim of this review was to describe some current indications of EUS in gastrointestinal and pancreatico-billiary diseases.

Pancreatic Fluid Collection Drainage by Endoscopic Ultrasound: An Update

Endoscopic management of symptomatic pancreatic fluid collections (PFCs) is now considered to be first line therapy. Expanded use of endoscopic ultrasound (EUS) techniques has resulted in increased applicability, safety, and efficacy of endoscopic transluminal PFC drainage. Steps include EUS-guided trangastric or transduodenal fistula creation into the PFC followed by stent placement or nasocystic drain deployment in order to decompress the collection. With the remarkable improvement in the available accessories and stents and development of exchange free access device; EUS drainage techniques have become simpler and less time consuming. The use of self-expandable metal stents with modifications to drain PFC has helped in overcoming some previously encountered challenges. PFCs considered suitable for endoscopic drainage include collection present for greater than 4 weeks, possessing a well-formed wall, position accessible endoscopically and located within 1 cm of the duodenal or gastric walls. Indications for EUS-guided drainage have been increasing which include unusual location of the collection, small window of entry, nonbulging collections, coagulopathy, intervening varices, failed conventional transmural drainage, indeterminate adherence of PFC to the luminal wall or suspicion of malignancy. In this article, we present a review of literature to date and discuss the recent developments in EUS-guided PFC drainage.

EUS-guided drainage is more successful in pancreatic pseudocysts compared with abscesses

To compare the results for endoscopic ultrasound (EUS)-guided drainage of clear fluid pancreatic pseudocysts with the results for abscess drainage. All patients referred for endoscopic drainage of a fluid collection were prospectively included. The outcome was recorded. Altogether 26 pseudocysts or abscesses were treated in 25 (6 female) patients. One endoscopist performed the procedures. Non-infected pseudocysts were present in 15 patients and 10 patients had infected fluid collections. The cyst size ranged between 28 cm × 13 cm and 5 cm × 5 cm. The EUS drainage was successful in 94% of the pseudocysts and in 80% of the abscesses (P = 0.04). The complication rate in pseudocysts was 6% and in abscesses was 30% (P = 0.02). Recurrence of a pseudocyst occurred in one patient (4%) after 6 mo; the patient was successfully retreated. EUS-guided drainage of pseudocysts is associated with a higher success rate and a lower complication rate compared with abscess drainage.

Therapeutic Success of Endoscopic Ultrasound-Guided Drainage of Pancreatic Pseudocysts in a Pediatric Population

Background: Endoscopic drainage has become established as the primary therapy for pancreatic pseudocysts (PC) in adults. Endoscopic ultrasound (EUS) has improved the safety and efficacy of transmural drainage by identification of blood vessels, wall thickness and most optimal site for cyst puncture. However, the management of symptomatic PC among children is less clear regarding the role of EUS. Aim: The aim of this study was to evaluate the success and safety of linear EUS-guided drainage of symptomatic pancreatic PC in children. Methods: Children who presented to our institution between 1/2004 and 8/2008 with symptomatic PC were included. All patients had pancreatic cysts noted on CT imaging. EUS was performed with the curvilinear array Olympus endoscope (GFUC140-P or GFUCT140) and either 19- or 22-guage Cook aspiration needles. Antibiotic prophylaxis was administered prior to endoscopy. PC was confirmed by the appearance on CT and/or EUS, fluid aspiration with histology and in certain cases elevated fluid amylase and low fluid CEA levels. Complete aspiration of smaller cysts was attempted. In other cysts, one to two 10 Fr double pig-tailed plastic stents were placed for 8 weeks and removed after resolution of the PC. Results: The group included 9 patients age <18years (4-17years), (6 females, 3 males). Etiologies of pancreatitis and PC included biliary stones (2), trauma (2), idiopathic (3), familial (1), and divisum (1). Indications for therapy included fever (2), pain (5) and impaired oral intake (2). In the initial cases, EUS served as a salvage therapy for failed ERCP (2), then a combined modality (2), and finally the primary modality to treat pancreatic cysts (5). Cysts larger than 5 cm required EUS-guided cyst-gastrostomy with placement of transmural stents while smaller cysts could be successfully aspirated alone. One patient (familial pancreatitis) had initial success with cyst drainage but developed a second PC during recurrent pancreatitis 8 months later which necessitated surgical intervention for hemosuccus pancreaticus. The remaining 8 patients (89%) had complete resolution of symptoms without recurrence. In 3 of 9 patients, infected cysts were present and were treated successfully with EUS-guided transmural stent placement. Conclusions: EUS drainage of pancreatic PC is safe with durable symptom relief in a pediatric population. Cysts smaller than 5cm can be aspirated successfully without stent placement. Infected cysts can be managed effectively with transmural stents. This series demonstrates that the need for ERCP has diminished over time as the use of EUS-guided PC drainage has evolved into the primary modality.