Clinical Characteristics and Efficacy of Percutaneous Catheter Drainage in Children with Acute Lymphoblastic Leukemia Complicated by Asparaginase-Associated Pancreatitis and Ascites

Abstract Objective To summarize the clinical characteristics of children with acute lymphoblastic leukemia (ALL) complicated by asparaginase-associated pancreatitis (AAP) and ascites, and to evaluate the efficacy of percutaneous catheter drainage (PCD) using an ascites depth > 30 mm as the intervention threshold in patients with mild AAP. Methods A retrospective analysis was conducted on 47 children diagnosed with ALL who developed AAP following asparaginase chemotherapy at Children's Hospital of Soochow University between January 2022 and December 2024. AAP severity was classified according to the modified Atlanta criteria and the Pediatric Sequential Organ Failure Assessment (pSOFA) score into mild (n = 40), moderately severe (n = 3), and severe (n = 4) groups. Abdominal ultrasound with a maximum ascites depth > 30 mm was used as the indication for PCD. Clinical outcomes, including fasting duration, total hospital stay, and pancreatic enzyme recovery time, were compared between the PCD group (n = 18) and the conservative treatment group (n = 10) among mild AAP patients with ascites. Statistical analyses were performed using the Mann-Whitney U test and Fisher's exact test. Results Among the 47 AAP patients, 28 (59.6%) were male and 19 (40.4%) were female, with a median age of 6.5 years (range: 1.5–14.5 years). Mild AAP was identified in 40 patients (85.1%), moderately severe AAP in 3 (6.4%), and severe AAP in 4 (8.5%). Ascites was present in 35 patients (74.5%), and all 7 patients with moderately severe or severe AAP had ascites. Among the 28 mild AAP patients with ascites depth > 30 mm, 18 underwent PCD and 10 received conservative treatment, with no significant differences in baseline characteristics between the two groups (P > 0.05 for all). The PCD group had significantly shorter fasting duration (median 7.0 days vs. 10.5 days, P = 0.031) and total hospital stay (median 26.0 days vs. 31.0 days, P = 0.043) compared to the conservative group. No significant differences were observed in the recovery times of serum amylase, urinary amylase, or lipase between the two groups (P > 0.05 for all). One patient (5.6%) in the PCD group developed puncture site oozing, while in the conservative group, two patients (20.0%) required temporary puncture due to progressive ascites accumulation and one (10.0%) developed a pancreatic pseudocyst. All 7 patients with moderately severe or severe AAP underwent PCD, and all 4 patients with severe AAP died. Conclusion PCD using an ascites depth > 30 mm as the intervention threshold significantly shortened fasting duration and total hospital stay in children with mild AAP, with favorable safety profile. This approach may serve as an effective intervention strategy for AAP complicated by significant ascites.