Pancreatic duct (PD) leaks and pancreatic fluid collections (pseudocyst/walled-off pancreatic necrosis [WOPN]) are rare in children and adolescents, and the optimal minimally invasive approach is not well established. Transpapillary PD stenting (with or without sphincterotomy) is the principal endoscopic treatment for partial duct disruptions and low-grade leaks. Pediatric series report high technical success with stent placement and good clinical resolution in a majority of cases; reported closure/success rates vary but are commonly in the ~70–90% range in mixed-age cohorts, with procedure-specific complication rates (including post-ERCP pancreatitis) that require caution. Smaller-caliber stents (5–7 Fr) and pediatric-appropriate accessories are used when available.EUS-guided drainage is safe and effective for symptomatic pseudocysts and select walled-off necrosis (WON), though data are smaller and largely single-center. Nasocystic irrigation, multiple plastic stents, or LAMS with step-up necrosectomy are used based on collection content. We aimed to describe outcomes of ERCP-based transpapillary therapy and EUS-guided drainage for PD leaks and associated collections in a combined pediatric–adolescent cohort. 

We conducted a single-centre retrospective case series of 20 patients (age 4–19 years) treated between January 2021 and October 2025. Data included pancreatitis aetiology (acute vs chronic), clinical presentation, PD leak location on imaging (CECT/MRCP/EUS/ERCP), endoscopic procedures performed, need for adjunct percutaneous or pleural drainage, and outcomes. Primary endpoints were technical success and durable clinical/radiologic resolution without recurrence.  

Nine of 20 patients had acute pancreatitis (three trauma-related), and 11 had chronic pancreatitis with an acute exacerbation. Presentations included symptomatic pseudocyst/WOPN (n=10), pancreatic ascites (n=7), left paracolic gutter collection (n=2), and pleural involvement (effusion or pancreatico-pleural fistula; n=2). PD leaks were located in the body (n = 11), neck (n = 7), and tail (n = 2). All patients underwent endoscopic therapy, including ERCP (transpapillary PD stenting in 9, pancreatic sphincterotomy alone in 1) and EUS-guided cystogastrostomy with plastic stent(s) in 7, as well as EUS-guided single-time aspiration (EUS-STA) in 3. In the ERCP group, collections were managed with percutaneous catheter drainage (n=4), therapeutic paracentesis (n=5), and thoracentesis (n=1) before transpapillary intervention; only 1 EUS-cystogastrostomy patient required an additional PCD drain. Technical success was 100% for EUS-guided interventions (cystogastrostomy/EUS-STA, 10/10) and 90% for transpapillary PD stenting (9/10). Patients required 1–4 ERCP sessions; stent dwell time ranged from 2 to 12 months. Over 2–24 months of follow-up, no recurrences were documented.  

Endoscopic therapy (ERCP-based transpapillary PD stenting and EUS-guided cystogastrostomy) provided safe, organ-preserving, and durable control of PD leaks and peri-pancreatic fluid collections in children and adolescents, with high technical success and absence of recurrence in this series. A tailored strategy—EUS-guided cystogastrostomy for symptomatic pseudocyst/WOPN and ERCP-based stenting for demonstrable PD leaks—appears effective, while adjunct percutaneous or pleural drainage is only selectively required. Larger prospective multicentre studies are needed to refine procedural algorithms, stent selection and dwell time, and to assess long-term pancreatic function, growth, quality of life, and recurrence risk in this population.