Endoscopic Treatment of Walled-off Necrosis in Children: Clinical Experience and Treatment Outcomes.
Endoscopic Treatment of Walled-off Necrosis in Children: Clinical Experience and Treatment Outcomes.
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DOI：
10.1097/mpg.0000000000001269
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发表时间：
2016-09-01
影响因子：
2.9
通讯作者：
Varadarajulu, Shyam
中科院分区：
文献类型：
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作者：
Bang, Ji Young;Varadarajulu, Shyam
目的：有关内窥镜治疗儿童壁状坏死(Won)结果的数据有限。本研究的目的是评价经鼻内窥镜治疗儿童WIN的有效性和安全性。方法：对所有6年以上有症状的WIN患儿进行回顾性研究。治疗包括内窥镜超声引导下的跨壁引流，使用与管腔相对的金属支架或多个7Fr双猪尾巴塑料支架，并加或不加经皮引流。主要观察指标为技术成功、治疗成功、复发、再干预和不良事件。结果：6名儿童(5名女孩，中位年龄12岁)接受了内窥镜超声引导下WIN引流，其中5名患者创建了单一跨壁管，1名患者创建了多条跨壁管，5名患者放置了塑料支架，1名患者放置了贴壁金属支架，1名患者同时接受了经皮引流。治疗成功6例(100%)，其中4例为单次干预，2例为2次干预。未发生与手术相关的不良事件。在8周的随访中，除1例胰管分离的患者外，所有患者均被取回了跨壁支架。平均随访781天(四分位数间隔336-869天)，无一例复发或症状复发。结论：内窥镜治疗是有效的、安全的，当可用时应成为儿童WIN治疗的一线方法。
OBJECTIVES: Data on the endoscopic treatment outcomes for walled-off necrosis (WON) in children are limited. The aim of the present study was to evaluate the efficacy and safety of endoscopic approach for the treatment of WON in children.METHODS: A retrospective study was conducted of all children with symptomatic WON treated endoscopically over 6 years. Treatment consisted of endoscopic ultrasound-guided transmural drainage using either a lumen-apposing metal stent or multiple 7Fr double pigtail plastic stents with or without percutaneous drainage. Main outcome measures were technical success, treatment success, recurrence, reinterventions, and adverse events.RESULTS: Six children (5 girls, median age 12 years) underwent endoscopic ultrasound-guided WON drainage by creation of a single transmural tract in 5 patients and multiple transmural tracts in 1. Stents placed were plastic in 5 patients and lumen-apposing metal stent in 1. One patient underwent concomitant percutaneous drainage. Treatment success was achieved in all of the 6 patients (100%) following a single intervention in 4 patients and 2 interventions in 2. No procedure-related adverse events were encountered. At 8-week follow-up, the transmural stents were retrieved in all but 1 patient who had a disconnected pancreatic duct. At a median follow-up of 781 days (interquartile range 336-869 days), no WON or symptom recurrence was encountered in any patient.CONCLUSIONS: Endoscopic treatment is effective, safe, and when available should be the first-line modality for the management of WON in children.