Management of pancreatic pseudocysts in pediatric oncology patients

Yousef El-Gohary, Sara Mansfield, Jessica Staszak, Abdelhafeez Abdelhafeez, Lindsay Talbot, Ching Hon Pui, Robert Gold, Andrew J. Murphy, Andrew M. Davidoff

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

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

Original languageEnglish
Pages (from-to)1727-1731
Number of pages5
JournalJournal of Pediatric Surgery
Volume55
Issue number9
DOIs
StatePublished - Sep 2020

Keywords

  • Leukemia
  • PEG-asparaginase
  • Pancreatic pseudocyst
  • Pancreatitis

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