Endoscopic Ultrasound-guided Drainage of Pancreatic Fluid Collections in children.
ABSTRACT BACKGROUND:: Although 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. OBJECTIVE:: To evaluate the efficacy and safety of single-step EUS-guided drainage of PFCs in children. MATERIALS AND METHODS:: This is a retrospective study of all children who underwent single-step EUS-guided drainage of PFCs over a 4-year period at one institution. An ERCP was attempted prior to EUS-guided drainage to evaluate the pancreatic duct and bridge any ductal disruption. RESULTS:: Seven children (boys = 4; mean age 8.4yrs [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 (IQR = 12-20 minutes). Two patients underwent repeat EUS-guided drainage due to lack of adequate resolution of PFC on follow-up CT. There were no immediate or delayed complications. At a median follow-up of 1033 days (IQR = 193 - 1167 days), all children were doing well with no PFC recurrence. CONCLUSION:: 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.
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ABSTRACT: 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;