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Agrawal S, Arya A, Gautam AD, Yadav RR, Singh A, Boruah D, Mohindra S, Gupta A, Srivastava A, Gurjar M, Singh RK, Rahul R. Current Utility of Transgastric Percutaneous Drainage for the Management of Pancreatitis-Related Retrogastric Walled-Off Necrotic Collections: A Prospective Observational Study. Cureus 2024; 16:e56443. [PMID: 38638772 PMCID: PMC11024891 DOI: 10.7759/cureus.56443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/20/2024] Open
Abstract
Introduction Pancreatic fluid collection (PFC) is one of the most frequent complications associated with acute pancreatitis. The route of drainage is guided by the size and site of collection. The present study aims to assess the clinical and technical success of transgastric percutaneous drainage (PCD) for managing retrogastric walled-off pancreatic necrosis (WOPN). Materials and methods A total of 44 patients with acute pancreatitis diagnosed with WOPN who underwent transgastric PCD with ultrasound or CT guidance as part of standard clinical management were included in the study. Patients were observed for improvement in clinical parameters, and treatment outcomes were noted in terms of technical success, clinical success, adverse events, need for additional procedures, hospital stay, and duration of placement of all drains. Data for the internalization of transgastric PCD was also observed in the study. Results Technical success during the drain placement was observed in 93% (n=41) of patients.Internalization of the transgastric drain was attempted in 12 patients and successful in 11 (91%). The median duration of hospital stay from the time of placement of the first PCD until discharge and the median duration of all PCDs placed were higher in patients where the transgastric drain was not internalized as compared to patients where the transgastric drain was internalized. Conclusion In WOPN, transgastric drain placement and successful internalization in any form help in the early resolution of peripancreatic and abdominal collections. It also reduces the time to percutaneous catheter removal, which in turn reduces the morbidity and decreases the need for additional interventions or surgery.
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Affiliation(s)
- Sarthak Agrawal
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Asmita Arya
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Avinash D Gautam
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rajanikant R Yadav
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Ashish Singh
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Deb Boruah
- Radiology, All India Institute of Medical Sciences, Guwahati, IND
| | - Samir Mohindra
- Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Archana Gupta
- Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Anshu Srivastava
- Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Mohan Gurjar
- Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rajneesh K Singh
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
| | - Rahul Rahul
- Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND
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Purschke B, Bolm L, Meyer MN, Sato H. Interventional strategies in infected necrotizing pancreatitis: Indications, timing, and outcomes. World J Gastroenterol 2022; 28:3383-3397. [PMID: 36158258 PMCID: PMC9346450 DOI: 10.3748/wjg.v28.i27.3383] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
Acute pancreatitis (AP) is one of the most common gastrointestinal diseases and remains a life-threatening condition. Although AP resolves to restitutio ad integrum in approximately 80% of patients, it can progress to necrotizing pancreatitis (NP). NP is associated with superinfection in a third of patients, leading to an increase in mortality rate of up to 40%. Accurate and early diagnosis of NP and associated complications, as well as state-of-the-art therapy are essential to improve patient prognoses. The emerging role of endoscopy and recent trials on multidisciplinary management of NP established the “step-up approach”. This approach starts with endoscopic interventions and can be escalated to other interventional and ultimately surgical procedures if required. Studies showed that this approach decreases the incidence of new multiple-organ failure as well as the risk of interventional complications. However, the optimal interventional sequence and timing of interventional procedures remain controversial. This review aims to summarize the indications, timing, and treatment outcomes for infected NP and to provide guidance on multidisciplinary decision-making.
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Affiliation(s)
- Birte Purschke
- Department of Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Louisa Bolm
- Department of Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Max Nikolaus Meyer
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Hiroki Sato
- Department of Medicine, Asahikawa Medical University, Asahikawa 0788510, Hokkaido, Japan
- Department of Gastroenterology, Asahikawa Kosei Hospital, Asahikawa 0788211, Hokkaido, Japan
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Siddiqui A, Naveed M, Basha J, Lakhtakia S, Nieto J, Shah J, Binmoeller K, Murphy M, Talukdar R, Ramchandani MK, Nabi Z, Gupta R, Kowalski TE, Loren DE, Sharaiha RZ, Kahaleh M, Eyck PT, Noor A, Mumtaz T, Kalalala R, Reddy ND, Adler DG. International, multicenter retrospective trial comparing the efficacy and safety of bi-flanged versus lumen-apposing metal stents for endoscopic drainage of walled-off pancreatic necrosis. Ann Gastroenterol 2021; 34:273-281. [PMID: 33654370 PMCID: PMC7903561 DOI: 10.20524/aog.2021.0570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 09/10/2020] [Indexed: 02/07/2023] Open
Abstract
Background To compare fully covered bi-flanged metal stents (BFMS) and lumen-apposing metal stents (LAMS) for endoscopic ultrasound (EUS)-guided drainage/debridement of pancreatic walled-off necrosis (WON). Methods Patients with WON managed by EUS-guided therapy were divided into those who underwent: 1) drainage using BFMS; and 2) drainage using LAMS and scheduled direct endoscopic necrosectomy (DEN). Clinical success (resolution of the WON), technical success (successful stent placement), and adverse events (AEs) were evaluated. Results 387 patients underwent WON endoscopic drainage, 205 using BFMS and 182 using LAMS. The clinical success in the BFMS or LAMS groups were similar (197 [96.1%] vs. 174 [95.6%]; P=0.81). Median number of procedures required for WON resolution was significantly lower in BFMS compared to LAMS (2 vs. 3, P<0.001). Technical success for stent placement was similar in BFMS and LAMS groups (203 [99%] vs. 180 [99%], P=0.90). Procedure-related AEs were similar in the BFMS and LAMS groups (19 [9.3%] vs. 20 [10.9%], P=0.61). Stent dysfunction with occluding debris was higher in the BFMS group compared to LAMS group (21 [10.2 %] vs. 11 [5.9%], P=0.04). The migration rate was higher in the BFMS group than in the LAMS group (15 [7.3%] vs. 3 [1.6%]; P<0.001). DEN was required in 23 [11.2%] patients in the BFMS group after lack of WON resolution by conservative means. Conclusion BFMS with a “step-up approach” and LAMS with scheduled DEN are both safe and effective for EUS-guided drainage/debridement of WON.
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Affiliation(s)
- Ali Siddiqui
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Mariam Naveed
- University of Iowa, Iowa City, IA, USA (Mariam Naveed, Patrick Ten Eyck)
| | - Jahangeer Basha
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Sundeep Lakhtakia
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Jose Nieto
- Borland-Groover Clinic, Jacksonville, FL, USA (Jose Nieto)
| | - Janak Shah
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA, USA (Janak Shah, Kenneth Binmoeller)
| | - Kenneth Binmoeller
- Division of Gastroenterology, California Pacific Medical Center, San Francisco, CA, USA (Janak Shah, Kenneth Binmoeller)
| | - Megan Murphy
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Rupjyoti Talukdar
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Mohan K Ramchandani
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Rajesh Gupta
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Thomas E Kowalski
- New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA (Thomas E. Kowalski, Reem Z. Sharaiha, Michel Kahaleh)
| | - David E Loren
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Reem Z Sharaiha
- New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA (Thomas E. Kowalski, Reem Z. Sharaiha, Michel Kahaleh)
| | - Michel Kahaleh
- New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA (Thomas E. Kowalski, Reem Z. Sharaiha, Michel Kahaleh)
| | - Patrick Ten Eyck
- University of Iowa, Iowa City, IA, USA (Mariam Naveed, Patrick Ten Eyck)
| | - Arish Noor
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Tayebah Mumtaz
- Thomas Jefferson University, Philadelphia, PA, USA (Ali Siddiqui, Megan Murphy, David E. Loren, Arish Noor, Tayeban Mumtaz)
| | - Rakesh Kalalala
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Nageshwar D Reddy
- Asian Institute of Gastroenterology, Hyderabad, India (Jahangeer Basha, Sundeep Lakhtakia, Rupjyoti Talukdar, Mohan K. Ramchandani, Zaheer Nabi, Rajesh Gupta, Rakesh Kalalala, Nageshwar D. Reddy)
| | - Douglas G Adler
- University of Utah, Salt Lake City, UT, USA (Douglas G. Adler)
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Outcomes of early endoscopic intervention for pancreatic necrotic collections: a matched case-control study. Gastrointest Endosc 2020; 91:1303-1309. [PMID: 31958461 DOI: 10.1016/j.gie.2020.01.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Pancreatic necrosis may be categorized as an acute necrotic collection (ANC) or walled-off necrosis (WON) based on complete encapsulation by a wall and collection age (≤4 weeks or >4 weeks). Endoscopic intervention of WON has become the standard of care, but little is known regarding the safety and efficacy of endoscopic intervention of pancreatic necrosis ≤4 weeks from disease onset. METHODS Retrospective review of medical records and imaging studies of all patients undergoing early endoscopic intervention of pancreatic necrosis between 2008 and 2018 was carried out at 1 referral center. Patients who underwent previous interventional treatment were excluded. Control WON patients were matched to early intervention cases. The primary outcome was defined as resolution of the collection after endoscopic treatment, without surgery. RESULTS Nineteen patients with early intervention were identified. The most common indication for intervention was infection. Median age of these collections at the time of initial endoscopic intervention was 23 days (range, 15-27 days), and all collections had a partial or complete wall discernable on contrast-enhanced CT. Eleven patients underwent concurrent endoscopic necrosectomy. The primary outcome was achieved in all patients in the early intervention group. Total duration of therapy was longer for early intervention compared with controls (103 vs 69 days, P = .042), with no mortality and similar adverse event rates compared with controls. CONCLUSIONS Endoscopic intervention of pancreatic necrosis in the third and fourth weeks of illness appears effective and safe when a partial collection wall is present on cross-sectional imaging studies, with outcomes paralleling those reported for intervention of WON.
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Yan L, Dargan A, Nieto J, Shariaha RZ, Binmoeller KF, Adler DG, DeSimone M, Berzin T, Swahney M, Draganov PV, Yang DJ, Diehl DL, Wang L, Ghulab A, Butt N, Siddiqui AA. Direct endoscopic necrosectomy at the time of transmural stent placement results in earlier resolution of complex walled-off pancreatic necrosis: Results from a large multicenter United States trial. Endosc Ultrasound 2019; 8:172-179. [PMID: 29882517 PMCID: PMC6590004 DOI: 10.4103/eus.eus_108_17] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives EUS-guided drainage, and direct endoscopic necrosectomy (DEN) of walled-off necrosis (WON) using a lumen-apposing metal stent (LAMS) is safe and effective. Early debridement of WON may improve overall clinical outcomes. The aim of this study is to perform a multicenter retrospective study to compare the clinical outcomes and predictors of success for endoscopic drainage of WON with LAMS followed by immediate or delayed DEN performed at standard intervals. Methods Patients with WON managed by EUS-guided drainage with LAMS were divided into 2 groups: (1) those that underwent immediate DEN at the time of stent placement and (2) those that underwent delayed DEN 1 week after stent placement. DEN was subsequently performed every 1-2 week (s). Technical success (successful placement of LAMS), adverse events (AEs), and clinical success (complete resolution of the WON) were evaluated. Results Totally, 271 patients underwent WON drainage with LAMS: 69 who underwent immediate DEN and 202 who underwent delayed DEN. The technical success for LAMS placement was 100% in both groups. There was no significant difference in the overall procedural AEs between the immediate and delayed DEN groups (P = 7.2% vs. 9.4%; P = 0.81). Stent dislodgement during index endoscopy occurred in three patients in the immediate DEN group compared to zero in the delayed DEN group (P = 0.016); all three dislodgements occurred during necrosectomy. Clinical success for WON resolution in the immediate DEN group was 91.3% compared to 86.1% in the delayed DEN group (P = 0.3). The mean number of necrosectomy sessions for WON resolution was significantly lower in the immediate DEN group compared to the delayed DEN group (3.1 vs. 3.9, P < 0.001). Performing DEN at the time of stent placement was an independent predictor for resolution of WON with lesser number of DEN sessions (odds ratio 2.3; P = 0.004). Conclusions DEN at the time of initial stent placement reduces the number of necrosectomy sessions required for successful clinical resolution of WON.
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Affiliation(s)
- Linda Yan
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew Dargan
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose Nieto
- Division of Gastroenterlogy, Borland Groover Clinic, Jacksonville, FL, USA
| | - Reem Z Shariaha
- Division of Gastroenterlogy, Department of Internal Medicine, Weill Cornell Medical Center, New York City, NY, USA
| | - Kenneth F Binmoeller
- Division of Gastroenterlogy, Department of Internal Medicine, California Pacific Medical Center, San Francisco, CA, USA
| | - Douglas G Adler
- Division of Gastroenterlogy, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Michael DeSimone
- Division of Gastroenterlogy, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tyler Berzin
- Division of Gastroenterlogy, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mandeep Swahney
- Division of Gastroenterlogy, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Peter V Draganov
- Division of Gastroenterlogy, Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - Dennis J Yang
- Division of Gastroenterlogy, Department of Internal Medicine, University of Florida, Gainesville, FL, USA
| | - David L Diehl
- Division of Gastroenterlogy, Department of Internal Medicine, Geisinger Health System, Danville, PA, USA
| | - Lillian Wang
- Division of Gastroenterlogy, Department of Internal Medicine, Geisinger Health System, Danville, PA, USA
| | - Asma Ghulab
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Nausharwan Butt
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ali A Siddiqui
- Division of Gastroenterlogy, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Imaging of endoscopic cystogastrostomy in pancreatic walled-off necrosis: what the radiologist needs to know. Abdom Radiol (NY) 2018; 43:3043-3053. [PMID: 29619526 DOI: 10.1007/s00261-018-1584-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis is a frequent entity encountered by radiologists. In 2012, the Atlanta criteria were revised to help radiologists use a common nomenclature when describing acute pancreatitis and its complications. One delayed complication of acute necrotizing pancreatitis in walled-off necrosis, a collection seen at least 4 weeks after an episode of acute pancreatic necrosis and/or acute peripancreatic necrosis. Multiple treatments have been adapted in the setting of walled-off necrosis, including endoscopic cystogastrostomy. The focus of this article is to familiarize the radiologist with the imaging appearance of this procedure as well as, review the outcomes and potential complications of endoscopic cystogastrostomy.
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Nabi Z, Lakhtakia S, Basha J, Chavan R, Gupta R, Ramchandani M, Kalapala R, Pal P, Darisetty S, Rao GV, Nageshwar Reddy D. Endoscopic drainage of pancreatic fluid collections: Long-term outcomes in children. Dig Endosc 2017; 29:790-797. [PMID: 28374894 DOI: 10.1111/den.12884] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/29/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Endoscopic drainage of pancreatic fluid collections (PFC) is the standard of care in adult patients. The literature is limited in children. In the present study, we aim to evaluate the safety and long-term efficacy of endoscopic ultrasound (EUS)-guided drainage of PFC in children. METHODS Data of all children (<18 years) with PFC who underwent EUS-guided drainage with plastic stents were analyzed retrospectively for technical feasibility, clinical efficacy and adverse events (AE). RESULTS Thirty children (boys 22, girls 8) with PFC underwent EUS drainage (January 2013 to June 2016). Mean age of children was 13.07 ± 3.41 years (5-17 years). Majority of children had idiopathic pancreatitis (23), followed by trauma-related (6) and gallstone-related pancreatitis (1). Of 30 PFC, 13 (43.3%) and 17 (56.7%) were classified as pseudocyst and walled-off necrosis, respectively. Median size of PFC was 95 mm (61-175). EUS drainage was successfully completed in 29 children (technical success 96.7%). Clinical success was achieved in 28/30 (93.3%) children. AE included perforation (2), major bleed (1), minor bleed (2), stent migration (4) and readmission as a result of hematemesis (1). Imaging revealed disconnected pancreatic duct in nine, ductal leak in two and stricture in one child. Cystogastric stents were left in situ in children with disconnected duct. At median follow up of 829 days (150-1230), two recurrences of PFC were noticed. CONCLUSIONS EUS-guided drainage using plastic stents is safe and effective in children with PFC. Cystogastric plastic stents can be left safely long term. However, more studies with larger sample sizes are required.
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Affiliation(s)
- Zaheer Nabi
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | | | - Rajesh Gupta
- Asian Institute of Gastroenterology, Hyderabad, India
| | | | | | - Partha Pal
- Asian Institute of Gastroenterology, Hyderabad, India
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