Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population

Abstract

Background and Objectives:The safety and utility of endoscopic ultrasound (EUS) for the evaluation and management of gastrointestinal (GI) tract disorders among adults has been established. The literature on safety and efficacy in a pediatric referral population (under 21 years of age) is limited. We hypothesized that EUS is safe and useful in the pediatric population. We reviewed the pediatric EUS experience at a single tertiary-care system. We describe the indications, findings, safety, technical success rate, and impact on clinical outcomes.Patients and Methods:All patients 21 years of age or younger referred for EUS between 5, 2007 and 11, 2012 were identified from our electronic medical record databases. Retrospective chart review was then conducted to document demographics, procedure indications, procedure type (diagnostic or therapeutic), type of anesthesia used, EUS findings, and the clinical impact of EUS on the subsequent management of the patients.Results:Seventy EUS procedures were attempted in 58 patients during the study. Of these, two EUS procedures were aborted due to inadequate moderate sedation and 68 were successfully completed. The median age at initial endoscopy was 18 years (range 6–21 years), 50% were male and 65% were Caucasian. Four patients underwent EUS-guided pseudocyst drainage. Among the remaining 54 patients, the indications for EUS were the evaluation of GI mucosal/submucosal lesions (n = 14), acute or recurrent pancreatitis (n = 10), localization of suspected insulinoma (n = 8), evaluation of pancreatic abnormalities seen on prior imaging (n = 6), surveillance of tumors or evaluation of luminal lesions in hereditary syndromes (n = 6), abdominal pain of suspected pancreatobiliary origin (n = 5), and other rare indications (n = 5). Fine-needle aspiration was performed in 13 (9 diagnostic, 4 therapeutic) and trans-gastric fine-needle contrast injection of the pancreatic duct was performed in one patient without any complications. Sedation (data available for 66 procedures) included general endotracheal anesthesia in 38 (57%), monitored anesthesia care (MAC) in 19 (29%), and moderate sedation in 9 (14%). There were 4 minor intra-procedural anesthesia-related complications (laryngospasm in 2 and hypoxemia from airway obstruction and secretions in 2) in MAC and general endotracheal anesthesia (GA) cases, and 1 postprocedural complication (fever after pseudocyst drainage). EUS can achieve the diagnostic or therapeutic goal and ruled out suspected pathology in 88% of cases precluding need for additional testing.Conclusions:(1) EUS in the pediatric population is technically successful and efficacious. (2) Therapeutic and diagnostic EUS impacted clinical care decisions. (3) There is a low risk of immediate significant complications. (4) The overall efficacy and safety support the performance of EUS in a pediatric population by experienced endoscopists.

Role of endoscopic ultrasound in pediatric patients: A single tertiary center experience and review of the literature

“…Therapeutic EUS was performed in 16 cases (7 pancreatic pseudocyst drainage, 7 celiac plexus block, 1 EUS-guided transgastric biliary drainage[ 4 , 6 - 8 , 15 , 16 ] and 1 mediastinal bronchogenic cyst aspiration in our study). The incidence rate of EUS-related complications ranged between 1.96% and 7.1%; which was reported in only 4 studies[ 3 , 4 , 6 , 16 ]. Complications included mild pancreatitis after FNA of solid pancreatic lesions, fever and bleeding after EUS-guided cystogastrostomy and anesthesia-related complications (hypoxia due to airway obstruction and laryngospasm).…”

“…This was comparable to the study by Varadarajulu et al[ 10 ], who reported that EUS had a significant impact on the clinical care of 13 out of 14 patients (93%) with pancreaticobiliary disorders. Similarly, Raina et al[ 16 ] reported a significant impact on clinical care in 88% of cases and AlRashdan et al[ 7 ] reported a different diagnosis achieved by EUS in 86% of cases. These data suggest that EUS when performed by expert endosonographers is safe, feasible, and has a significant impact on the clinical care of pediatric patients.…”

“…Herein, we report the experience of a single tertiary center in the use of EUS and EUS-FNA in a pediatric population and compare the findings to the most relevant studies in the literature assessing the role of EUS in children (Table 3 ). A total of 12 studies[ 3 - 12 , 15 , 16 ] were published between 1998 and 2019 including 524 patients and 584 EUS procedures. The age of the enrolled patients ranged between 0.5 and 21 years.…”

“…EUS-FNA was performed in 7 patients and a definite diagnosis was achieved in all patients allowing them to undergo appropriate management (patients with pancreatic NET, SPN, and rectal GIST underwent surgery, those with mediastinal and abdominal lymphomas started chemotherapy, peri-gastric postpancreatitis collection resolved with antibiotics, and a mediastinal bronchogenic cyst was completely aspirated). A commonly reported therapeutic indication for EUS in pediatrics is the drainage of pancreatic fluid collections[ 4 , 15 , 16 ]. In the present study, the child who presented with a large mediastinal bronchogenic cyst (10 cm × 7.6 cm) underwent successful EUS-guided aspiration of the cyst content with no recurrence within 6 mo after aspiration.…”

Endoscopic Ultrasound in pediatric patients. First experience

“…При этом авторы сходятся во мнении, что эндо-УЗИ оказалось полезным методом, в подавляющем большинстве наблюдений оказавшим влияние на выбор или изменение тактики лечения (табл. 2) [13][14][15][16][17].…”