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Pancreatic Pseudocyst Drainage with a LASEMS in an 11-Year-Old


Beauvais, Jacques MD1; Javed, Safeera MD2; Ramachandran, Rajesh MD1; Ho, Sammy MD, FASGE, FACG, NYSGEF1

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American Journal of Gastroenterology: October 2016 - Volume 111 - Issue - p S736
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Introduction: Endoscopic ultrasound guided drainage of pancreatic fluid collections (PFCs) has evolved significantly over the past two decades. The emergence of lumen-apposing self-expandable metallic stents (LASEMS) has revolutionized this endoscopic technique. This stent has a unique design which allows for high success rates when compared to the traditionally used plastic stents. This case describes the utility of the LASEMS in an 11 year old child with a pancreatic pseudocyst.

Case Report: An 11 year old girl presented with a one month history of worsening abdominal pain associated with bilious emesis. Imaging revealed extensive pancreatitis and a 10x10 cm peri-pancreatic fluid collection consistent with a pseudocyst. She was scheduled for drainage via cystogastrostomy. A linear array echo endosonoscope was used which showed the cyst size to be over 6 cm in diameter. The wall of the cyst was punctured with a 15 mm LASEMS. The stent was successfully deployed and 600cc of brown fluid was aspirated. The procedure was without complications. She had an interval imaging which showed reduction in the size of the pseudocyst and the stent was found to be in place. She will have a repeat imaging in 4- 6 weeks followed by stent removal, if the cyst has been shown to have resolved.

Discussion: The LASEMS has been designed specifically for the drainage of pancreatic pseudocysts. Its innovative design incorporates two large flanges at either end of the stent to hold apposing tissue layers together and to prevent stent migration. The first reported series documenting the use of the LASEMS for patients with symptomatic pancreatic pseudocysts were done mainly in adults. This case report demonstrates the successful use of LASEMS in the pediatric population.

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