Exploring lumen-apposing metal stents as a novel approach for managing walled-off necrosis in pediatric acute pancreatitis in Indian cohort: a prospective study

Abstract

Background: Walled-off necrosis (WON) is a severe complication of acute pancreatitis in children, with limited evidence on its endoscopic management. This study evaluated the efficacy and safety of endoscopic ultrasonography (EUS)-guided lumen-apposing metal stent (LAMS) placement for WON in pediatric patients.

Methods: This open-label prospective study included pediatric patients aged 5-18 years with WON secondary to acute necrotizing pancreatitis that was managed with EUS-guided LAMS at a tertiary center from January 2021 to July 2023. Clinical success, defined as symptom resolution and WON clearance at 12 weeks, was the primary outcome. Secondary outcomes included technical success, complications, and the need for additional interventions.

Results: Eleven patients (mean age, 15.5±3.1 years) were included. Clinical success was achieved in 90.9% of the patients within 12 weeks, with a 100% technical success rate. Two patients experienced stent occlusions that were managed with saline irrigation; one case required video-assisted retroperitoneal debridement. The mean hospital stay was 5.4±3.3 days. No major adverse events were reported.

Conclusions: EUS-guided LAMS placement is a safe and effective alternative to surgery for pediatric WON, with high clinical and technical success rates and minimal complications. Further multicenter studies are required to validate these findings.

Keywords: Child; Endoscopy; Endosonography; Pancreatic pseudocyst; Pancreatitis; Pediatrics.

Fig. 1.

A flowchart of the study. A total of 11 patients were enrolled; 9 required no additional endoscopic interventions, and the primary outcome was achieved in 10 patients. VARD, video-assisted retroperitoneal debridement.

Fig. 2.

Magnetic resonance imaging (MRI) of pediatric patients with walled-off necrosis (WON). Axial T2-weighted MRI images of four pediatric patients demonstrate large, well-encapsulated WON marked by black asterisks (*). (A) A heterogeneous fluid collection with internal debris located in the pancreatic and peripancreatic region. (B) A predominantly cystic WON located in the lesser sac, exerting mass effect on adjacent structures. (C) A large encapsulated collection with a fluid-debris level occupying most of the upper abdomen, displacing the stomach and bowel loops. (D) A clearly demarcated fluid collection with minimal internal debris located near the pancreatic tail.

Fig. 3.

(A, B) Endoscopic images depict lumen-apposing metal stent draining solid necrotic debris (marked with *). (C, D) Endoscopic ultrasound images depict walled-off necrosis (WON) (I depicts the liquid component and II is the necrotic debris) and the endoscopic ultrasonography needle in the WON cavity.