EUS in Pediatrics: A Multicenter Experience and Review

Abstract

Background/Aim: Endoscopic ultrasound (EUS) is a well-established tool used in the evaluation and treatment of a wide range of pathologies in adult medicine. EUS in pediatrics has been shown to be safe and technically effective, and its use continues to evolve. This article aims to describe the EUS experience at our tertiary-care centers with regard to safety, technical success, and its impact in clinical management. We also discuss the current and developing diagnostic and therapeutic uses for EUS in pediatrics such as in pancreaticobiliary disease, congenital anomalies, eosinophilic esophagitis, inflammatory bowel disease, and liver disease.Methods: This is a retrospective review of EUS performed by two pediatric gastroenterologists trained as endosonographers between April 2017 and November 2020. Patient demographics, procedure indication, procedure characteristics, technical success, and complications were collected. Literature review was performed to describe current and future uses of EUS in pediatrics.Results: Ninety-eight EUS were performed with 15 (15.3%) including fine needle aspiration/biopsy and 9 (9.2%) cases being therapeutic. Most common indications include choledocholithiasis (n = 31, 31.6%), pancreatic fluid collections (n = 18, 18.4%), chronic and acute recurrent pancreatitis (n = 14, 14.3%), and acute pancreatitis characterization (n = 13, 13.3%). Notable indications of pancreatic mass (n = 6, 6.1%) and luminal lesions/strictures (n = 6, 6.1%) were less common. Complications were limited with one instance of questionable GI bleeding after cystgastrostomy creation. Ninety-eight of 98 (100%) cases were technically successful.Conclusion/Discussion: EUS has been shown to be performed safely and successfully in the pediatric population by pediatric endosonographers. This study and review support its use in pediatric practice and demonstrate the wide variety of indications for EUS such as pancreatic cystgastrostomy, celiac plexus neurolysis, and evaluation of chronic pancreatitis. This literature review also demonstrates areas of potential development for EUS within the practice of pediatric gastroenterology.

Endoscopic Ultrasonography in Children with Eosinophilic Esophagitis—A Review

“…EUS is a procedure during which an endoscopic examination of the gastrointestinal tract and an ultrasound examination of nearby organs are carried out. Additionally, the possibility of performing a fine-needle aspiration biopsy during this procedure makes it more often used in everyday clinical practice, mainly in adults [ 7 ]. In addition, the importance of EUS in children is currently growing.…”

“…This examination has significantly enriched the diagnostic and therapeutic options for many childhood diseases. EUS has proven to be useful in the evaluation and treatment of pediatric conditions including pancreatic and biliary diseases, congenital anomalies, submucosal lesions, cholelithiasis, monitoring inflammatory bowel disease and eosinophilic esophagitis [ 7 , 8 , 9 ]. Several pediatric studies have demonstrated the high utility of EUS in combination with fine-needle and thick-needle aspiration biopsies, which are technically feasible and relatively safe also in children [ 7 , 9 ].…”

“…EUS has proven to be useful in the evaluation and treatment of pediatric conditions including pancreatic and biliary diseases, congenital anomalies, submucosal lesions, cholelithiasis, monitoring inflammatory bowel disease and eosinophilic esophagitis [ 7 , 8 , 9 ]. Several pediatric studies have demonstrated the high utility of EUS in combination with fine-needle and thick-needle aspiration biopsies, which are technically feasible and relatively safe also in children [ 7 , 9 ]. Therapeutic procedures associated with EUS include endoscopic cystogastrostomy, neurolysis of the visceral plexus, and biliary and pancreatic prosthesis [ 9 ].…”

“…This is related to the low availability of this procedure in children and the heterogeneity of the pediatric population (e.g., different age- and height-dependent wall thickness norms). The heterogeneity of the pediatric population related to age and height particularly limits the performance of EUS in younger children, mainly due to lack of appropriate equipment and the need of general anesthesia [ 7 ]. However, there are reports in the literature concerning the assessment of the usefulness of EUS in children with EoE.…”

“…A new commercially available tool for the assessment of esophageal motility disorders especially in terms of lower sphincter function (compliance, diameter) is the Endoluminal Functional Lumen Imaging Probe (FLIP), but due to lack of standards, especially in children, it is currently not widely used [ 25 ]. Despite the numerous potential benefits of EUS in children with EoE ( Table 2 ), this method has some significant limitations, as in the case of using EUS for indications other than EoE (the need for sedation, no equipment appropriate for the child’s size) [ 7 ]. However, the most important limitation is the lack of validated standards for the esophageal TWT and its layers in children.…”