Endoscopic Drainage of Walled Off Necrosis in a Child With Metal Stent
A 12-year-old child presented with persistent pain abdomen and vomiting after an episode of acute necrotizing pancreatitis 6 weeks ago. Evaluation revealed a large walled off necrosis (WON) with significant amount of debris in body and tail of pancreas. Endoscopic ultrasound (EUS)-guided drainage was planned for the child. Linear EUS scope (Olympus 180, Japan; outer diameter: 14.6 mm, channel: 3.7 mm) was used. The wall of WON was punctured with a 19 G regular FNA needle, followed by aspiration of cyst fluid for visual inspection and analysis (amylase and microbial culture sensitivity). Subsequently the guidewire with flexible tip (0.025 in.; 450 cm) was passed and coiled inside the WON cavity under fluoroscopy. The cystogastric tract was dilated over the guidewire with 6 Fr cystotome (Endoflex, Voerde, Germany) followed by small-caliber balloon dilatation (Hurricane, 4 mm, Boston, Natick, MA). Finally, the metal stent (14 × 20 mm; Taewoong Medical, Gyeonggi-do, South Korea) was deployed. The rapid flow of pancreatic fluid collection content through the stent into stomach along with the satisfactory position (on EUS, endoscopic view and fluoroscopy) were confirmed. There were no intraprocedural or postprocedural adverse events. The stent was removed after 4 weeks and imaging revealed near complete resolution of WON. The child has completed 9 weeks of follow-up without recurrence of WON. The video is available as Supplemental Digital Content and can be viewed at http://links.lww.com/MPG/A895.