Tu Irene Wen Hui, Koh Zong Jie, Ho Khek Yu, Karthik Sivaramakrishnan Venkatesh, Mali Vidyadhar Padmakar
Department of Paediatric Surgery, National University Hospital, Singapore 119074, Singapore.
Division of Gastroenterology, Department of Medicine, National University Hospital, Singapore 119074, Singapore.
Children (Basel). 2025 Jul 23;12(8):965. doi: 10.3390/children12080965.
Pancreatic fluid collections (PFCs) in acute pancreatitis require drainage when symptomatic or infected. Walled-off necrosis (WON) is difficult to drain with plastic stents alone. A lumen-apposing metal stent (LAMS) offers larger calibre drainage, lower migration risk than conventional methods, and the option of direct endoscopic necrosectomy through the stent. However, the paediatric literature on LAMSs is sparse. We report our institutional experience, and summarise current evidence on the feasibility, efficacy and safety of LAMSs for PFC drainage in children. We performed a retrospective study at the National University Hospital (NUH) and a full review of the literature on LAMS use in children for endoscopic trans-gastric drainage of PFCs from April 2012 to September 2024. There were, respectively, 2 (males, 10 and 17 years) and 18 children who underwent endoscopic trans-gastric LAMS insertion for drainage of PFCs in acute pancreatitis in the NUH and across the nine included studies, which were published between 2015 and 2024. The technical and clinical success was 100%. There were no complications during insertion or indwell time (28 and 50 days in the NUH and 40 days, range of 7-100 days in the systematic review, respectively). Endoscopic removal of LAMSs was uneventful. There were no recurrent PFCs over a 4-month (1,7 months) and 12-month (range, 2-44 months) follow-up, respectively. Migration of LAMSs to colon following the collapse of the WON was reported in one case. : An transgastric LAMS (with trans-stent necrosectomy) is a technically feasible method of drainage of WON following acute pancreatitis in children with minimal complications.
急性胰腺炎中的胰液积聚（PFCs）在出现症状或感染时需要引流。包裹性坏死（WON）仅用塑料支架很难引流。管腔对接金属支架（LAMS）提供更大口径的引流，比传统方法迁移风险更低，并且可选择通过支架进行直接内镜坏死组织清除术。然而，关于LAMS在儿科的文献较少。我们报告我们机构的经验，并总结目前关于LAMS用于儿童PFC引流的可行性、有效性和安全性的证据。我们在国立大学医院（NUH）进行了一项回顾性研究，并全面回顾了2012年4月至2024年9月期间关于儿童使用LAMS进行内镜经胃引流PFCs的文献。在NUH以及纳入的9项研究（发表于2015年至2024年）中，分别有2名儿童（男性，10岁和17岁）和18名儿童接受了内镜经胃插入LAMS以引流急性胰腺炎中的PFCs。技术和临床成功率为100%。插入或留置期间均无并发症（在NUH分别为28天和50天，在系统评价中为40天，范围为7 - 100天）。内镜取出LAMS顺利。在4个月（1.7个月）和12个月（范围为2 - 44个月）的随访中，分别无PFC复发。有1例报告WON塌陷后LAMS迁移至结肠。经胃LAMS（联合经支架坏死组织清除术）是儿童急性胰腺炎后WON引流的一种技术上可行的方法，并发症最少。
