Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Outcomes of Endoscopic Drainage in Children with Pancreatic Fluid Collections: A Systematic Review and Meta-Analysis

  • Nabi, Zaheer (Department of Gastroenterology, Asian Institute of Gastroenterology) ;
  • Talukdar, Rupjyoti (Department of Gastroenterology, Asian Institute of Gastroenterology) ;
  • Lakhtakia, Sundeep (Department of Gastroenterology, Asian Institute of Gastroenterology) ;
  • Reddy, D. Nageshwar (Department of Gastroenterology, Asian Institute of Gastroenterology)
  • Received : 2021.08.26
  • Accepted : 2022.03.20
  • Published : 2022.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Endoscopic drainage is an established treatment modality for adult patients with pancreatic fluid collections (PFCs). Available data regarding the efficacy and safety of endoscopic drainage in pediatric patients are limited. In this systematic review and meta-analysis, we aimed to analyze the outcomes of endoscopic drainage in children with PFCs. Methods: A literature search was performed in Embase, PubMed, and Google Scholar for studies on the outcomes of endoscopic drainage with or without endoscopic ultrasonography (EUS) guidance in pediatric patients with PFCs from inception to May 2021. The study's primary objective was clinical success, defined as resolution of PFCs. The secondary outcomes included technical success, adverse events, and recurrence rates. Results: Fourteen studies (187 children, 70.3% male) were included in this review. The subtypes of fluid collection included pseudocysts (60.3%) and walled-off necrosis (39.7%). The pooled technical success rates in studies where drainage of PFCs were performed with and without EUS guidance were 95.3% (95% confidence interval [CI], 89.6-98%; I2=0) and 93.9% (95% CI, 82.6-98%; I2=0), respectively. The pooled clinical success after one and two endoscopic interventions were 88.7% (95% CI, 82.7-92.9%; I2=0) and 92.3% (95% CI, 87.4-95.4%; I2=0), respectively. The pooled rate of major adverse events was 6.3% (95% CI, 3.3-11.4%; I2=0). The pooled rate of recurrent PFCs after endoscopic drainage was 10.4% (95% CI, 6.1-17.1%; I2=0). Conclusion: Endoscopic drainage is safe and effective in children with PFCs. However, future studies are required to compare endoscopic and EUS-guided drainage of PFCs in children.

Keywords

References

  1. Husain SZ, Srinath AI. What's unique about acute pancreatitis in children: risk factors, diagnosis and management. Nat Rev Gastroenterol Hepatol 2017;14:366-72. https://doi.org/10.1038/nrgastro.2017.13
  2. Abu-El-Haija M, Kumar S, Quiros JA, Balakrishnan K, Barth B, Bitton S, et al. Management of acute pancreatitis in the pediatric population: a clinical report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas committee. J Pediatr Gastroenterol Nutr 2018;66:159-76. https://doi.org/10.1097/MPG.0000000000001715
  3. Varadarajulu S, Lopes TL, Wilcox CM, Drelichman ER, Kilgore ML, Christein JD. EUS versus surgical cyst-gastrostomy for management of pancreatic pseudocysts. Gastrointest Endosc 2008;68:649-55. https://doi.org/10.1016/j.gie.2008.02.057
  4. Lakhtakia S, Basha J, Talukdar R, Gupta R, Nabi Z, Ramchandani M, et al. Endoscopic "step-up approach" using a dedicated biflanged metal stent reduces the need for direct necrosectomy in walled-off necrosis (with videos). Gastrointest Endosc 2017;85:1243-52. https://doi.org/10.1016/j.gie.2016.10.037
  5. Nabi Z, Basha J, Reddy DN. Endoscopic management of pancreatic fluid collections-revisited. World J Gastroenterol 2017;23:2660-72. https://doi.org/10.3748/wjg.v23.i15.2660
  6. Bang JY, Arnoletti JP, Holt BA, Sutton B, Hasan MK, Navaneethan U, et al. An endoscopic transluminal approach, compared with minimally invasive surgery, reduces complications and costs for patients with necrotizing pancreatitis. Gastroenterology 2019;156:1027-40.e3. https://doi.org/10.1053/j.gastro.2018.11.031
  7. Nabi Z, Talukdar R, Reddy DN. Endoscopic management of pancreatic fluid collections in children. Gut Liver 2017;11:474-80. https://doi.org/10.5009/gnl16137
  8. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ 2021;372:n160.
  9. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003;73:712-6. https://doi.org/10.1046/j.1445-2197.2003.02748.x
  10. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13. https://doi.org/10.1186/1471-2288-5-13
  11. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014;14:135. https://doi.org/10.1186/1471-2288-14-135
  12. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88. https://doi.org/10.1016/0197-2456(86)90046-2
  13. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34. https://doi.org/10.1136/bmj.315.7109.629
  14. Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56:455-63. https://doi.org/10.1111/j.0006-341X.2000.00455.x
  15. Sharma SS, Maharshi S. Endoscopic management of pancreatic pseudocyst in children-a long-term follow-up. J Pediatr Surg 2008;43:1636-9. https://doi.org/10.1016/j.jpedsurg.2008.01.026
  16. Jazrawi SF, Barth BA, Sreenarasimhaiah J. Efficacy of endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population. Dig Dis Sci 2011;56:902-8. https://doi.org/10.1007/s10620-010-1350-y
  17. Makin E, Harrison PM, Patel S, Davenport M. Pancreatic pseudocysts in children: treatment by endoscopic cyst gastrostomy. J Pediatr Gastroenterol Nutr 2012;55:556-8. https://doi.org/10.1097/MPG.0b013e3182574fc9
  18. Agarwal J, Lakhtakia S, Gupta R, Ramchandani M, Rakesh K, Santosh D, et al. Role of endoscopic ultrasound (EUS) in children: a large single centre experience. United European Gastroenterol J 2013;1(Suppl 1):A336.
  19. Bai YZ. Endoscopic ultrasound-guided transgastric drainage of pancreatic pseudocysts in children. J Laparoendosc Adv Surg Tech A 2013;23:A-69.
  20. Ramesh J, Bang JY, Trevino J, Varadarajulu S. Endoscopic ultrasound-guided drainage of pancreatic fluid collections in children. J Pediatr Gastroenterol Nutr 2013;56:30-5. https://doi.org/10.1097/mpg.0b013e318267c113
  21. Bang JY, Varadarajulu S. Endoscopic treatment of walled-off necrosis in children: clinical experience and treatment outcomes. J Pediatr Gastroenterol Nutr 2016;63:e31-5. https://doi.org/10.1097/MPG.0000000000001269
  22. Nabi Z, Lakhtakia S, Basha J, Chavan R, Gupta R, Ramchandani M, et al. Endoscopic drainage of pancreatic fluid collections: long-term outcomes in children. Dig Endosc 2017;29:790-7. https://doi.org/10.1111/den.12884
  23. Nabi Z, Basha J, Lakhtakia S, Shava U, Pal P, Ramchandani M, et al. Disconnected pancreatic duct in children with walled off necrosis: impact on outcomes of endoscopic drainage. J Pediatr Gastroenterol Nutr 2019;69:116-9. https://doi.org/10.1097/mpg.0000000000002367
  24. Farr BJ, Fox VL, Mooney DP. Endoscopic cyst gastrostomy for traumatic pancreatic pseudocysts in children: a case series. Trauma Surg Acute Care Open 2020;5:e000456. https://doi.org/10.1136/tsaco-2020-000456
  25. Lal SB, Venkatesh V, Rana SS, Anushree N, Bhatia A, Saxena A. Paediatric acute pancreatitis: clinical profile and natural history of collections. Pancreatology 2020;20:659-64. https://doi.org/10.1016/j.pan.2020.03.007
  26. Ghoneem E, Okasha H, Shiha G, Soliman R, Gouda M, Ragab K. Safety and efficacy of endoscopic ultrasound as a diagnostic and therapeutic tool in pediatric patients: a multi-center study. Endoscopy 2021;53(Suppl 1):S246-7.
  27. Poddar U, Yachha SK, Upadhyaya VD, Kumar B, Borkar V, Malik R, et al. Endoscopic cystogastrostomy: still a viable option in children with symptomatic pancreatic fluid collection. Pancreatology 2021;21:812-8. https://doi.org/10.1016/j.pan.2021.02.004
  28. Seol KH, Kim SH, Oh SH, Kim KM. Clinical role of endoscopic ultrasound in paediatric gastrointestinal disease. J Pediatr Gastroenterol Nutr 2021;72(Suppl 1):391.
  29. Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012;307:1053-61. https://doi.org/10.1001/jama.2012.276
  30. Keane MG, Sze SF, Cieplik N, Murray S, Johnson GJ, Webster GJ, et al. Endoscopic versus percutaneous drainage of symptomatic pancreatic fluid collections: a 14-year experience from a tertiary hepatobiliary centre. Surg Endosc 2016;30:3730-40. https://doi.org/10.1007/s00464-015-4668-x
  31. Elmunzer BJ. Endoscopic drainage of pancreatic fluid collections. Clin Gastroenterol Hepatol 2018;16:1851-63.e3. https://doi.org/10.1016/j.cgh.2018.03.021
  32. Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association Clinical Practice Update: management of pancreatic necrosis. Gastroenterology 2020;158:67-75.e1. https://doi.org/10.1053/j.gastro.2019.07.064
  33. Varadarajulu S, Christein JD, Tamhane A, Drelichman ER, Wilcox CM. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc 2008;68:1102-11. https://doi.org/10.1016/j.gie.2008.04.028
  34. Park DH, Lee SS, Moon SH, Choi SY, Jung SW, Seo DW, et al. Endoscopic ultrasound-guided versus conventional transmural drainage for pancreatic pseudocysts: a prospective randomized trial. Endoscopy 2009;41:842-8. https://doi.org/10.1055/s-0029-1215133
  35. Lin TK, Troendle DM, Wallihan DB, Barth B, Fox VL, Fishman DS, et al. Specialized imaging and procedures in pediatric pancreatology: a North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition clinical report. J Pediatr Gastroenterol Nutr 2017;64:472-84. https://doi.org/10.1097/MPG.0000000000001371
  36. Trikudanathan G, Arain M, Mallery S, Freeman M, Attam R. Endoscopic necrosectomy in children. J Pediatr Gastroenterol Nutr 2014;59:270-3. https://doi.org/10.1097/MPG.0000000000000416