Lumen-Apposing Metal Stents for Endoscopic Transgastric Drainage of Pancreatic Fluid Collections in Children-A Case Report and Review of Safety and Efficacy.

Background/Objectives: Pancreatic fluid collections (PFCs) in acute pancreatitis require drainage when symptomatic or infected. Walled-off necrosis (WON) is difficult to drain with plastic stents alone. A lumen-apposing metal stent (LAMS) offers larger calibre drainage, lower migration risk than conventional methods, and the option of direct endoscopic necrosectomy through the stent. However, the paediatric literature on LAMSs is sparse. We report our institutional experience, and summarise current evidence on the feasibility, efficacy and safety of LAMSs for PFC drainage in children. Methods: We performed a retrospective study at the National University Hospital (NUH) and a full review of the literature on LAMS use in children for endoscopic trans-gastric drainage of PFCs from April 2012 to September 2024. Results: There were, respectively, 2 (males, 10 and 17 years) and 18 children who underwent endoscopic trans-gastric LAMS insertion for drainage of PFCs in acute pancreatitis in the NUH and across the nine included studies, which were published between 2015 and 2024. The technical and clinical success was 100%. There were no complications during insertion or indwell time (28 and 50 days in the NUH and 40 days, range of 7-100 days in the systematic review, respectively). Endoscopic removal of LAMSs was uneventful. There were no recurrent PFCs over a 4-month (1,7 months) and 12-month (range, 2-44 months) follow-up, respectively. Migration of LAMSs to colon following the collapse of the WON was reported in one case. Conclusions: An transgastric LAMS (with trans-stent necrosectomy) is a technically feasible method of drainage of WON following acute pancreatitis in children with minimal complications.