Endoscopic ultrasound-guided cystogastrostomy in the treatment of the complicated form of acute pancreatitis in children

Abstract

Acute pancreatitis is relatively rare in children, with approximately 3–13 cases per 100,000 populations annually, and complicated forms are three times less common than those in adults. However, recently, the number of acute pancreatitis cases in children has increased, which entails a relatively higher incidence of complicated acute pancreatitis, including parapancreatic acute fluid accumulation, and determines the relevance of this problem for pediatric surgeons.

In this study, using two sample observations, parapancreatic pseudocyst puncture under ultrasound and X-ray control was presented, a conductor string was introduced into the cavity of the pseudocyst, and further stenting of this anastomosis was performed with two plastic double-pigtail stents. In the first case, a 12-year-old boy underwent surgery for idiopathic pancreatitis and acute parapancreatic fluid accumulation in the pancreatic tail. In the second case, a 10-year-old girl presented with a parapancreatic pseudocyst, which was caused by drug-induced pancreatitis (a complication of the long-term use of valproic acid, an antiepileptic drug). Both children underwent surgery using this technique. Antisecretory therapy was performed postoperatively. In the catamnesis after 1 year and 6 months, the children had no complaints, and ultrasound and X-ray studies did not reveal any pathology. Endoscopic cystogastrostomy under ultrasound guidance is widely performed in complicated pancreatitis in adults. These observations show its effectiveness in pediatric practice. However, the relatively short observation period of treatment results requires additional research on a much larger number of cases and outcomes of these surgical interventions in children.

Keywords

acute pancreatitis / pseudocyst / parapancreatic fluid collection / cystogastroanastomosis / endoscopy / ultrasound navigation / children

References

[1] Lautz TB, Chin AC, Radhakrishnan J. Acute pancreatitis in children: spectrum of disease and predictors of severity. J Pediatr Surg. 2011;46(6):1144–1149. DOI: 10.1016/j.jpedsurg.2011.03.044

[2] Lautz T.B., Chin A.C., Radhakrishnan J. Acute pancreatitis in children: spectrum of disease and predictors of severity // J Pediatr Surg. 2011. Vol. 46, No. 6. P. 1144–1149. DOI: 10.1016/j.jpedsurg.2011.03.044

[3] Bai HX, Lowe ME, Husain SZ. What have we learned about acute pancreatitis in children? J Pediatr Gastroenterol Nutr. 2011;52(3):262–270. DOI: 10.1097/MPG.0b013e3182061d75

[4] Bai H.X., Lowe M.E., Husain S.Z. What have we learned about acute pancreatitis in children? // J Pediatr Gastroenterol Nutr. 2011. Vol. 52, No. 3. P. 262–270. DOI: 10.1097/MPG.0b013e3182061d75

[5] Suzuki M, Sai JK, Shimizu T. Acute pancreatitis in children and adolescents. World J Gastrointest Pathophysiol. 2014;5(4):416–426. DOI: 10.4291/wjgp.v5.i4.416

[6] Suzuki M., Sai J.K., Shimizu T. Acute pancreatitis in children and adolescents // World J Gastrointest Pathophysiol. 2014. Vol. 5, No. 4. P. 416–426. DOI: 10.4291/wjgp.v5.i4.416

[7] Uc A, Husain SZ. Pancreatitis in children. Gastroenterology. 2019;156(7):1969–1978. DOI: 10.1053/j.gastro.2018.12.043

[8] Uc A., Husain S.Z. Pancreatitis in children // Gastroenterology. 2019. Vol. 156. No. 7. P. 1969–1978. DOI: 10.1053/j.gastro.2018.12.043

[9] Hornung L, Szabo FK, Kalkwarf HJ, Abu-El-Haija M. Increased burden of pediatric acute pancreatitis on the health care system. Pancreas. 2017;46(9):1111–1114. DOI: 10.1097/MPA.0000000000000918

[10] Hornung L., Szabo F.K., Kalkwarf H.J., Abu-El-Haija M. Increased burden of pediatric acute pancreatitis on the health care system // Pancreas. 2017. Vol. 46, No. 9. P. 1111–1114. DOI: 10.1097/MPA.0000000000000918

[11] Morinville VD, Barmada MM, Lowe ME. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible? Pancreas. 2010;39(1):5–8. DOI: 10.1097/MPA.0b013e3181baac47

[12] Morinville V.D., Barmada M.M., Lowe M.E. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible? // Pancreas. 2010. Vol. 39, No. 1. P. 5–8. DOI: 10.1097/MPA.0b013e3181baac47

[13] Majbar AA, Cusick E, Johnson P, et al. Incidence and clinical associations of childhood acute pancreatitis. Pediatrics. 2016;138(3):e20161198. DOI: 10.1542/peds.2016-1198

[14] Majbar A.A., Cusick E., Johnson P., et al. Incidence and clinical associations of childhood acute pancreatitis // Pediatrics. 2016. Vol. 138, No. 3. ID e20161198. DOI: 10.1542/peds.2016-1198

[15] Pant C, Deshpande A, Sferra TJ, et al. Emergency department visits for acute pancreatitis in children: results from the Nationwide Emergency Department Sample 2006–2011. J Investig Med. 2015;63(4):646–648. DOI: 10.1097/JIM.0000000000000154

[16] Pant C., Deshpande A., Sferra T.J., et al. Emergency department visits for acute pancreatitis in children: results from the Nationwide Emergency Department Sample 2006–2011 // J Investig Med. 2015. Vol. 63, No. 4. P. 646–648. DOI: 10.1097/JIM.0000000000000154

[17] Kamalova AA, Urazmanova IM, Khayretdinova RF, Badretdinova AN. Current international guidelines for the diagnosis and treatment of acute pancreatitis in children. Pediatrician (St. Petersburg). 2019;10(4):79–87. (In Russ.) DOI: 10.17816/PED10479-87

[18] Камалова А.А., Уразманова И.М., Хайретдинова Р.Ф., Бадретдинова А.Н. Современные международные рекомендации по диагностике и терапии острых панкреатитов у детей // Педиатр. 2019. Т. 10, № 4. С. 79–87. DOI: 10.17816/PED10479-87

[19] Suzuki M, Saito N, Naritaka N, et al. Scoring system for the prediction of severe acute pancreatitis in children. Pediatr Int. 2015;57(1):113–118. DOI: 10.1111/ped.12449

[20] Suzuki M., Saito N., Naritaka N., et al. Scoring system for the prediction of severe acute pancreatitis in children // Pediatr Int. 2015. Vol. 57, No. 1. P. 113–118. DOI: 10.1111/ped.12449

[21] Lal SB, Venkatesh V, Rana SS, et al. Paediatric acute pancreatitis: clinical profile and natural history of collections. Pancreatology. 2020;20(4):659–664. DOI: 10.1016/j.pan.2020.03.007

[22] Lal S.B., Venkatesh V., Rana S.S., et al. Paediatric acute pancreatitis: clinical profile and natural history of collections // Pancreatology. 2020. Vol. 20, No. 4. P. 659–664. DOI: 10.1016/j.pan.2020.03.007

[23] Raizner A, Phatak UP, Baker K, et al. Acute necrotizing pancreatitis in children. J Pediatr. 2013;162(4):788–792. DOI: 10.1016/j.jpeds.2012.09.037

[24] Raizner A., Phatak U.P., Baker K., et al. Acute necrotizing pancreatitis in children // J Pediatr. 2013. Vol. 162, No. 4. P. 788–792. DOI: 10.1016/j.jpeds.2012.09.037

[25] Teh SH, Pham TH, Lee A, et al. Pancreatic pseudocyst in children: the impact of management strategies on outcome. J Pediatr Surg. 2006;41(11):1889–1893. DOI: 10.1016/j.jpedsurg.2006.06.017

[26] Teh S.H., Pham T.H., Lee A., et al. Pancreatic pseudocyst in children: the impact of management strategies on outcome // J Pediatr Surg. 2006. Vol. 41, No. 11. P. 1889–1893. DOI: 10.1016/j.jpedsurg.2006.06.017

[27] Chang Y-J, Chao H-C, Kong M-S, et al. Acute pancreatitis in children. Acta Paediatrica. 2011;100(5):740–744. DOI: 10.1111/j.1651-2227.2011.02158

[28] Chang Y.-J., Chao H.-C., Kong M.-S., et al. Acute pancreatitis in children // Acta Paediatrica. 2011. Vol. 100, No. 5. P. 740–744. DOI: 10.1111/j.1651-2227.2011.02158

[29] Russell KW, Barnhart DC, Madden J, et al. Non-operative treatment versus percutaneous drainage of pancreatic pseudocysts in children. Pediatr Surg Int. 2013;29(3):305–310. DOI: 10.1007/s00383-012-3236-x

[30] Russell K.W., Barnhart D.C., Madden J., et al. Non-operative treatment versus percutaneous drainage of pancreatic pseudocysts in children // Pediatr Surg Int. 2013. Vol. 29, No. 3. P. 305–310. DOI: 10.1007/s00383-012-3236-x

[31] Ratan SK, Rattan KN, Rohilla S, Magu S. Cystogastrostomy: a valid option for treating pancreatic pseudocysts of children in developing countries. Pediatr Surg Int. 2006;22(6):532–535. DOI: 10.1007/s00383-006-1674-z

[32] Ratan S.K., Rattan K.N., Rohilla S., Magu S. Cystogastrostomy: a valid option for treating pancreatic pseudocysts of children in developing countries // Pediatr Surg Int. 2006. Vol. 22, No. 6. P. 532–535. DOI: 10.1007/s00383-006-1674-z

[33] Rosenfeld EH, Vogel AM, Jafri M, et al. Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children. Pediatr Surg Int. 2019;35(8):861–867. DOI: 10.1007/s00383-019-04492-3

[34] Rosenfeld E.H., Vogel A.M., Jafri M., et al. Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children // Pediatr Surg Int. 2019. Vol. 35, No. 8. P. 861–867. DOI: 10.1007/s00383-019-04492-3

[35] Jazrawi SF, Barth BA, Sreenarasimhaiah J. Efficacy of endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population. Dig Dis Sci. 2011;56(3):902–908. DOI: 10.1007/s10620-010-1350-y

[36] Jazrawi S.F., Barth B.A., Sreenarasimhaiah J. Efficacy of endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population // Dig Dis Sci. 2011. Vol. 56, No. 3. P. 902–908. DOI: 10.1007/s10620-010-1350-y

[37] Makin E, Harrison PM, Patel S, Davenport M. Pancreatic pseudocysts in children: treatment by endoscopic cyst gastrostomy. J Pediatr Gastroenterol Nutr. 2012;55(5):556–558. DOI: 10.1097/MPG.0b013e3182574fc9

[38] Makin E., Harrison P.M., Patel S., Davenport M. Pancreatic pseudocysts in children: treatment by endoscopic cyst gastrostomy // J Pediatr Gastroenterol Nutr. 2012. Vol. 55, No. 5. P. 556–558. DOI: 10.1097/MPG.0b013e3182574fc9

[39] Patty I, Kalaoui M, Al-Shamali M, et al. Endoscopic drainage for pancreatic pseudocyst in children. J Pediatr Surg. 2001;36(3):503–505. DOI: 10.1053/jpsu.2001.21620

[40] Patty I., Kalaoui M., Al-Shamali M., et al. Endoscopic drainage for pancreatic pseudocyst in children // J Pediatr Surg. 2001. Vol. 36, No. 3. P. 503–505. DOI: 10.1053/jpsu.2001.21620

[41] Sharma SS, Maharshi S. Endoscopic management of pancreatic pseudocyst in children — a long-term follow-up. J Pediatr Surg. 2008;43(9):1636–1639. DOI: 10.1016/j.jpedsurg.2008.01.026

[42] Sharma S.S., Maharshi S. Endoscopic management of pancreatic pseudocyst in children — a long-term follow-up // J Pediatr Surg. 2008. Vol. 43, No. 9. P. 1636–1639. DOI: 10.1016/j.jpedsurg.2008.01.026

[43] Sokolov YuYu, Efremenkov AM, Tumanian GT, et al. Laparoscopic procedures in children with pancreatic pseudocysts. Pediatric Surgery. 2019;23(5):243–247. (In Russ.) DOI: 10.8821/1560-9510-2019-23-5-243-247

[44] Соколов Ю.Ю., Ефременков А.М., Туманян Г.Т., и др. Лапароскопические вмешательства у детей с панкреатичекими псевдокистами // Детская хирургия. 2019. Т. 23, № 5. С. 243–247. DOI: 10.8821/1560-9510-2019-23-5-243-247

[45] Sokolov YuYu, Efremenkov AM, Tumanian GT, et al. Laparoscopic cyst jejunostomy for large pancreatic pseudocyst in a 4-year-old girl. Pediatrics. Consilium medicum. 2019;(3):78–81. (In Russ.) DOI: 10.26442/26586630.2019.3.190598

[46] Соколов Ю.Ю., Ефременков А.М., Туманян Г.Т., и др. Лапароскопическая цистоеюностомия у 4-летней девочки с псевдокистой поджелудочной железы больших размеров // Педиатрия. Consilium Medicum. 2019. № 3. С. 78–81. DOI: 10.26442/26586630.2019.3.190598

[47] Patel PA, Gibson C, Minhas KS, et al. Pancreatic pseudocyst drainage in children by image-guided cystogastrostomy and stent insertion. Pediatr Radiol. 2019;49:1816–1822. DOI: 10.1007/s00247-019-04471-9

[48] Patel P.A., Gibson C., Minhas K.S., et al. Pancreatic pseudocyst drainage in children by image-guided cystogastrostomy and stent insertion // Pediatr Radiol. 2019. Vol. 49. P. 1816–1822. DOI: 10.1007/s00247-019-04471-9

[49] Khan Sial G-Z, Qazi AQ, Yusuf MA. Endoscopic cystogastrostomy: minimally invasive approach for pancreatic pseudocyst. APSP J Case Rep. 2015;6(1):4.

[50] Khan Sial G.-Z., Qazi A.Q., Yusuf M.A. Endoscopic cystogastrostomy: minimally invasive approach for pancreatic pseudocyst // APSP J Case Rep. 2015. Vol. 6, No. 1. P. 4.

[51] Poddar U, Yachha SK, Upadhyaya VD, et al. Endoscopic cystogastrostomy: Still a viable option in children with symptomatic pancreatic fluid collection. Pancreatology. 2021;21(4):812–818. DOI: 10.1016/j.pan.2021.02.004

[52] Poddar U., Yachha S.K., Upadhyaya V.D., et al. Endoscopic cystogastrostomy: Still a viable option in children with symptomatic pancreatic fluid collection // Pancreatology. 2021. Vol. 21, No. 4. P. 812–818. DOI: 10.1016/j.pan.2021.02.004

[53] Jain AK, Singh SK, Jain S, Agrawal P. Endoscopic Ultrasound-Guided Pancreatic Pseudocyst Drainage in Children: A Case Series. J Indian Assoc Pediatr Surg. 2022;27(4):478–480. DOI: 10.4103/jiaps.jiaps_102_21

[54] Jain A.K., Singh S.K., Jain S., Agrawal P. Endoscopic Ultrasound-Guided Pancreatic Pseudocyst Drainage in Children: A Case Series // J Indian Assoc Pediatr Surg. 2022. Vol. 27, No. 4. P. 478–480. DOI: 10.4103/jiaps.jiaps_102_21

[55] Dalal A, Kamat N, Patil G, et al. Usefulness of endoscopic ultrasound in children with pancreatobiliary and gastrointestinal symptoms. Endosc Int Open. 2022;10(2):E192–E199. DOI:10.1055/a-1675-2291

[56] Dalal A., Kamat N., Patil G., et al. Usefulness of endoscopic ultrasound in children with pancreatobiliary and gastrointestinal symptoms // Endosc Int Open. 2022. Vol. 10, No. 2. P. E192–E199. DOI: 10.1055/a-1675-2291

[57] Ragab KM, El-Kassas M, Madkour A, et al. Safety and efficacy of endoscopic ultrasound as a diagnostic and therapeutic tool in pediatric patients: a multicenter study. Ther Adv Gastrointest Endosc. 2022;15:26317745221136767. DOI: 10.1177/26317745221136767

[58] Ragab K.M., El-Kassas M., Madkour A., et al. Safety and efficacy of endoscopic ultrasound as a diagnostic and therapeutic tool in pediatric patients: a multicenter study // Ther Adv Gastrointest Endosc. 2022. Vol. 15. ID 26317745221136767. DOI: 10.1177/26317745221136767

[59] Solodinina EN, Efremenkov AM, Fomicheva NV, et al. Therapeutic pancreaticobiliary endoscopy in children: case series. Russian Journal of Evidence-Based Gastroenterology. 2022;11(3):44-51. (In Russ.) DOI: 10.17116/dokgastro20221103144

[60] Солодинина Е.Н., Ефременков А.М., Фомичева Н.В., и др. Интервенционные эндоскопические вмешательства на поджелудочной железе у детей: серия клинических случаев // Доказательная гастроэнтерология. 2022. T. 11, № 3. С. 44–51. DOI: 10.17116/dokgastro20221103144

RIGHTS & PERMISSIONS

Eco-Vector