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. 2024 May 26;11(6):643.
doi: 10.3390/children11060643.

Single Center Experience of Eus-Guided Cystogastrostomy and Lumen-Apposing Metal Stent (LAMS) Positioning in Children with Pancreatic Fluid Collections: A Case Series

Annalisa Fiammetta Pasqualetto  1 , Giovanni Boroni  1   2 , Dario Moneghini  3 , Filippo Parolini  1   2 , Paolo Orizio  1 , Anna Lavinia Bulotta  1 , Guido Missale  3 , Daniele Alberti  1   2   4
Affiliations

Single Center Experience of Eus-Guided Cystogastrostomy and Lumen-Apposing Metal Stent (LAMS) Positioning in Children with Pancreatic Fluid Collections: A Case Series

Annalisa Fiammetta Pasqualetto et al. Children (Basel). .

Abstract

Pancreatic fluid collections (PFCs) are a well-known complication of pancreatitis. PFCs operative management includes percutaneous, endoscopic or surgical drainage. Even if in adult patients, endoscopic drainage is a well-established treatment, few data are available in pediatric setting. We report our single-center experience of EUS-guided cystogastrostomy and lumen-apposing metal stent (LAMS) positioning in children with PFCs; this, at the best of our knowledge, has never been reported before. All consecutive children with PFCs between April 2020 and November 2022 were enrolled in this retrospective study. PFCs were preoperatively evaluated with MRI or CT scan. All the procedures were performed under general anesthesia. A LAMS Hot-AxiosTM 10 × 15 mm was placed in all patients. We evaluated technical feasibility and clinical outcomes, including complications and recurrence rates. Follow-up included clinical observation, blood tests and US. EUS-guided cystogastrostomy was performed in 3 children (2 males; median age 13.2 years). Median maximum cyst diameter was 14.7 cm (range 10-22 cm). Technical and clinical success rates were 100%. No intra or post-operative complications occurred. Our experience suggests that this can be considered a safe and feasible treatment of PCFs even in the pediatric population, as long as the procedure is performed by an expert Endoscopist in a pediatric tertiary-level Center.

Keywords: LAMS; acute pancreatitis; endoscopic cyst-gastrostomy; pancreatic fluid collection; walled-off necrosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
EC-LAMS 10 × 15 mm. Endoscopic image of the gastric flange of EC-LAMS at the end of its release into the gastric lumen.
Figure 2
Figure 2
Final X-ray. X-ray performed at the end of the procedure that shows the EC-LAMS as a radiopaque dumbbell-shape object projected in the epigastrium.
Figure 3
Figure 3
Patient n°1 MRI. Pseudocyst in the omental bursa with maximum diameter 10 cm.
Figure 4
Figure 4
Patient n°2 MRI. Pseudocyst with maximum diameter 12 cm in the left hypochondrium in close proximity to the posterolateral wall of the stomach.
Figure 5
Figure 5
Patient n°3 CT. Necrotic-hemorrhagic pancreatitis (body/tail origin) with voluminous walled-off necrosis developing in the left quadrant (hypochondrium/flank; relations to stomach, spleen, kidney, descending colon), extending craniocaudal about 22 cm.
Figure 6
Figure 6
Patient n°3 MRI. Reduction of the walled-off necrosis; the device is in place (in the white circle).
See this image and copyright information in PMC

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