TY - JOUR
T1 - Management of pancreatic pseudocysts in pediatric oncology patients
AU - El-Gohary, Yousef
AU - Mansfield, Sara
AU - Staszak, Jessica
AU - Abdelhafeez, Abdelhafeez
AU - Talbot, Lindsay
AU - Pui, Ching Hon
AU - Gold, Robert
AU - Murphy, Andrew J.
AU - Davidoff, Andrew M.
N1 - Funding Information:
This research was supported by the American Syrian Lebanese Associated Charities (ALSAC/St. Jude Children’ Research Hospital) and the National Cancer Institute grant P30 CA021765 (St. Jude Cancer Center Support Grant).
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2020/9
Y1 - 2020/9
N2 - Background: Management of children with pancreatic pseudocysts has historically been adopted from the adult experience where pancreatic pseudocysts greater than 6 cm are unlikely to resolve without intervention. We reviewed the clinical course of pediatric oncology patients with pancreatic pseudocysts. Methods: A retrospective review of patients treated over a 15-year period was performed. Variables evaluated included cancer type, medications administered, clinical and imaging characteristics of the pancreatic pseudocysts, treatment and outcome. Results: A total of 132 patients with a median age of 13 (IQR, 9–17) years were identified with pancreatitis. Thirty-one (23.5%) patients developed a pancreatic pseudocyst, of which 84% were associated with PEG-asparaginase treatment. The median pseudocyst size was 7.6 (IQR, 4.4–9.9) cm with 59% being greater than 6 cm. Twenty-two (71%) patients with a pancreatic pseudocyst underwent successful conservative management, while only 9 (29%) required procedural intervention including six percutaneous drainage, one of whom recurred and required surgical cyst-enteric drainage. Two other patients had primary surgical cyst-enteric drainage and one patient underwent endoscopic retrograde cholangiopancreatography with stenting. The indication for intervention was worsening pain rather than pseudocyst imaging characteristics, size or serum amylase/lipase. Conclusion: Most medication-induced pancreatic pseudocysts in children being treated for cancer, regardless of pseudocyst size, can be managed non-operatively or with transgastric percutaneous drainage. The need for intervention can be safely dictated by patient symptoms. Level of evidence: III
AB - Background: Management of children with pancreatic pseudocysts has historically been adopted from the adult experience where pancreatic pseudocysts greater than 6 cm are unlikely to resolve without intervention. We reviewed the clinical course of pediatric oncology patients with pancreatic pseudocysts. Methods: A retrospective review of patients treated over a 15-year period was performed. Variables evaluated included cancer type, medications administered, clinical and imaging characteristics of the pancreatic pseudocysts, treatment and outcome. Results: A total of 132 patients with a median age of 13 (IQR, 9–17) years were identified with pancreatitis. Thirty-one (23.5%) patients developed a pancreatic pseudocyst, of which 84% were associated with PEG-asparaginase treatment. The median pseudocyst size was 7.6 (IQR, 4.4–9.9) cm with 59% being greater than 6 cm. Twenty-two (71%) patients with a pancreatic pseudocyst underwent successful conservative management, while only 9 (29%) required procedural intervention including six percutaneous drainage, one of whom recurred and required surgical cyst-enteric drainage. Two other patients had primary surgical cyst-enteric drainage and one patient underwent endoscopic retrograde cholangiopancreatography with stenting. The indication for intervention was worsening pain rather than pseudocyst imaging characteristics, size or serum amylase/lipase. Conclusion: Most medication-induced pancreatic pseudocysts in children being treated for cancer, regardless of pseudocyst size, can be managed non-operatively or with transgastric percutaneous drainage. The need for intervention can be safely dictated by patient symptoms. Level of evidence: III
KW - Leukemia
KW - PEG-asparaginase
KW - Pancreatic pseudocyst
KW - Pancreatitis
UR - http://www.scopus.com/inward/record.url?scp=85077923981&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2019.12.002
DO - 10.1016/j.jpedsurg.2019.12.002
M3 - Article
C2 - 31954554
AN - SCOPUS:85077923981
SN - 0022-3468
VL - 55
SP - 1727
EP - 1731
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 9
ER -