Endoscopic Ultrasound-guided Drainage of Pancreatic Fluid Collections in Children

Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Journal of pediatric gastroenterology and nutrition (Impact Factor: 2.63). 07/2012; 56(1). DOI: 10.1097/MPG.0b013e318267c113
Source: PubMed


Background and objective:
Although endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs) has evolved as the standard of care in adults, its role as a single-step drainage modality in children is unclear. The aim of the present study was to evaluate the efficacy and safety of single-step EUS-guided drainage of PFCs in children.

This is a retrospective study of all of the children who underwent single-step EUS-guided drainage of PFCs during a 4-year period at 1 institution. An endoscopic retrograde cholangiopancreatography was attempted before EUS-guided drainage to evaluate the pancreatic duct and bridge any ductal disruption.

A total of 7 children (4 boys; mean age 8.4 years [standard deviation 2.1]) underwent EUS-guided drainage of PFCs. The etiology was blunt abdominal trauma in 5, hereditary pancreatitis in 1, and idiopathic pancreatitis in 1. Both technical and treatment success rates were 100% with median procedural duration of 12 minutes (interquartile range 12-20 minutes). Two patients underwent repeat EUS-guided drainage due to lack of adequate resolution of PFC on follow-up computed tomography. There were no immediate or delayed complications. At a median follow-up of 1033 days (interquartile range 193-1167 days), all of the children were doing well with no PFC recurrence.

Single-step EUS-guided drainage of PFC in children is technically feasible, safe, clinically effective, and when available, should be the first-line treatment modality.

8 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Opinion statement: Endoscopic ultrasound (EUS) is not only a diagnostic tool but also an interventional and therapeutic procedure. Indeed, in addition to tissue acquisition, it can also drain fluid collections adjacent to the gastrointestinal tract, provide access to biliary and pancreatic ducts, biliary, pancreatic, and gallbladder drainage, pancreatic cyst ablation, and, finally, provide anti-tumoral treatments and interventional vascular procedures. Although several improvements have been made in the last decade, the full potential of interventional EUS is yet to be completely explored. Future areas of research are the development of dedicated tools and accessories, the standardization of the interventional procedures, and the widening of the use of EUS, while increasing the expertise worldwide. In addition, more data, based on well-performed, possibly randomized clinical trials, are needed to accurately determine the risks and long-term outcomes of these interventions. We firmly believe that interventional EUS can play a pivotal role in anti-tumor treatments, by the fine-needle injection of anti-tumoral agents, tumor ablation, and assisting radiation treatment with gold fiducial placement and the implantation of intralesional seeds. The goal of the near future will be to offer targeted therapy and monitoring of tumor treatment response in a more biologically driven manner than has been available in the past. Interventional EUS will be an essential part of the multidisciplinary approach to cancer treatment.
    Current Treatment Options in Gastroenterology 03/2014; 12(2). DOI:10.1007/s11938-014-0015-x
  • [Show abstract] [Hide abstract]
    ABSTRACT: Handlebar injuries are one of the most common causes of abdominal injuries in children. We aim to investigate the epidemiology of bicycle handlebar injuries and to emphasize the severity of the injuries. A retrospective analysis of children admitted to our hospital with abdominal injury related to bicycle handlebars was performed. A total of 219 children (187 males and 32 females) younger than 17 years were hospitalized for abdominal handlebar injuries between 2005 and 2013. The age range of the patients was 4-17 (mean 10.93 ± 3.68) years. Most patients had an imprint of the handlebar edge on their abdomen. The most common abdominal organ injury was liver laceration. 33 patients had pancreas injury and 13 patients had hollow organ injury. Most patients were treated conservatively. Surgery was performed in 24 patients. Hospital stay was 4-60 (mean 9.63 ± 13.37) days. Trend of bicycle handlebar trauma over this time period was related to the local floating population and economy. The most common abdominal organ injury was liver. Hollow organ injury required emergency exploratory laparotomy and the Roux-y anastomosis applied well in cases whose gastrointestinal tract damaged seriously. Pancreatic injury usually led to secondary pseudocyst. The percutaneous ultrasound-guided drainage of pancreatic pseudocyst was really an effective way. The trend in the amylase and lipase levels could reflect the pancreatic injury condition and predict prognosis. Early diagnosis and optimal care without delay may help to reduce the morbidity of injuries to the internal organs. Children with abdominal handlebar injuries should be treated with great care.
    European Journal of Trauma and Emergency Surgery 11/2014; DOI:10.1007/s00068-014-0477-5 · 0.35 Impact Factor