Nabi Zaheer, Talukdar Rupjyoti, Reddy D Nageshwar
Asian Institute of Gastroenterology, Hyderabad, India.
Gut Liver. 2017 Jul 15;11(4):474-480. doi: 10.5009/gnl16137.
The incidence of acute pancreatitis in children has increased over the last few decades. The development of pancreatic fluid collection is not uncommon after severe acute pancreatitis, although its natural course in children and adolescents is poorly understood. Asymptomatic fluid collections can be safely observed without any intervention. However, the presence of clinically significant symptoms warrants the drainage of these fluid collections. Endoscopic management of pancreatic fluid collection is safe and effective in adults. The use of endoscopic ultrasound (EUS)-guided procedure has improved the efficacy and safety of drainage of pancreatic fluid collections, which have not been well studied in pediatric populations, barring a scant volume of small case series. Excellent results of EUS-guided drainage in adult patients also need to be verified in children and adolescents. Endoprostheses used to drain pancreatic fluid collections include plastic and metal stents. Metal stents have wider lumens and become clogged less often than plastic stents. Fully covered metal stents specifically designed for pancreatic fluid collection are available, and initial studies have shown encouraging results in adult patients. The future of endoscopic management of pancreatic fluid collection in children appears promising. Prospective studies with larger sample sizes are required to establish their definitive role in the pediatric age group.
在过去几十年中，儿童急性胰腺炎的发病率有所上升。严重急性胰腺炎后胰腺液体积聚的情况并不少见，尽管其在儿童和青少年中的自然病程尚不清楚。无症状的液体积聚可以安全观察，无需任何干预。然而，出现具有临床意义的症状则需要对这些液体积聚进行引流。胰腺液体积聚的内镜治疗在成人中是安全有效的。内镜超声（EUS）引导下的操作提高了胰腺液体积聚引流的疗效和安全性，这在儿科人群中尚未得到充分研究，仅有少量小病例系列报道。EUS引导下引流在成人患者中的出色效果也需要在儿童和青少年中得到验证。用于引流胰腺液体积聚的内支架包括塑料支架和金属支架。金属支架的管腔更宽，堵塞的频率比塑料支架低。专门为胰腺液体积聚设计的全覆膜金属支架已经问世，初步研究在成人患者中显示出令人鼓舞的结果。儿童胰腺液体积聚的内镜治疗前景似乎很乐观。需要进行更大样本量的前瞻性研究，以确定其在儿童年龄组中的明确作用。
