Catheter Drainage Tied to Faster Recovery in Children With Leukemia-Related Pancreatitis

Children undergoing treatment for acute lymphoblastic leukemia sometimes develop asparaginase-associated pancreatitis, a serious complication of their chemotherapy that is frequently accompanied by ascites.

The researchers reviewed the records of 47 children with acute lymphoblastic leukemia who developed asparaginase-associated pancreatitis while being treated under the CCLG-ALL-2020 protocol between January 2022 and December 2024. The patients had a median age of 6.5 years, and 59.6 percent were male. Using the INSPPIRE criteria and the NASPGHAN Pancreas Committee classification, the team graded disease severity: 40 children, or 85.1 percent, had mild pancreatitis, 3 (6.4 percent) had moderately severe disease, and 4 (8.5 percent) had severe disease. Ascites developed in 35 of the 47 patients, or 74.5 percent.

The analysis focused on a subgroup of 28 children with mild pancreatitis whose abdominal fluid depth exceeded 30 millimeters on imaging. Notably, this threshold was not chosen in advance; it was defined retrospectively from the data. Because treatment was not randomized, the investigators compared patients according to the treatment they actually received, using Mann-Whitney U and Fisher’s exact tests.

The results suggest a possible benefit of drainage in this selected group. Children who underwent percutaneous catheter drainage had a shorter fasting duration, with a median of 7.0 days compared with 10.5 days in the conservatively treated group, a difference that reached statistical significance at P = 0.031. Their total hospital stay was also shorter, at a median of 26.0 days versus 31.0 days (P = 0.043). Recovery times for pancreatic enzymes, the laboratory markers of pancreatic injury, were similar between the two groups, with no statistically significant differences.

Complication patterns differed between the groups. One patient in the drainage group, or 5.6 percent, developed self-limited oozing at the puncture site, a minor procedural side effect that resolved on its own.

The outlook was far grimmer for the most severely affected children. All four patients classified as having severe asparaginase-associated pancreatitis died despite receiving percutaneous catheter drainage. This finding underscores that drainage, whatever its role in mild disease, did not alter the course of severe pancreatitis in this small series.

The authors themselves are careful about the limits of their work. In their conclusion, they emphasize that the 30-millimeter fluid-depth threshold was retrospectively defined and data-derived, making it prone to selection bias and lacking external validation. Because the study was small and non-randomized, and because treatment assignment reflected clinical judgment rather than chance, the observed associations between drainage and shorter fasting or hospital stay cannot establish that drainage caused the better outcomes. Sicker or less sick children may simply have been selected for one approach or the other in ways the retrospective design cannot untangle.

With those caveats in place, the findings are best described as hypothesis-generating. The study suggests that in children with mild asparaginase-associated pancreatitis and abdominal fluid deeper than 30 millimeters, catheter drainage might shorten fasting time and hospitalization, while carrying a low rate of procedural complications in this cohort. The authors state explicitly that these results require confirmation in larger prospective studies before percutaneous catheter drainage can be recommended as standard practice for mild disease.

For clinicians caring for children with leukemia, the study adds a data point to an area where evidence has been thin.

Subject of Research: Percutaneous catheter drainage for asparaginase-associated pancreatitis with ascites in children with acute lymphoblastic leukemia

Article Title: Clinical characteristics and association of percutaneous catheter drainage in children with acute lymphoblastic leukemia complicated by asparaginase-associated pancreatitis and ascites

Article References: Wanting, X., Chunyan, G., Saihu, H., Hailong, H., Dongni, S., Xiangming, Y., Zhenjiang, B., Shuiyan, W., & Xingqiang, D. (2026). Clinical characteristics and association of percutaneous catheter drainage in children with acute lymphoblastic leukemia complicated by asparaginase-associated pancreatitis and ascites. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07824-0

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07824-0

Keywords: acute lymphoblastic leukemia, asparaginase-associated pancreatitis, ascites, percutaneous catheter drainage, pediatrics, retrospective study, CCLG-ALL-2020, INSPPIRE criteria, pancreatic pseudocyst, hospital stay, Clinical, characteristics