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

Abstract

BACKGROUND Although endoscopic ultrasound (EUS) is now widely available and has an established role in adults, the utility of EUS and EUS-guided fine needle aspiration (EUS-FNA) in pediatrics is insufficiently described compared to adults and is supported by only a few studies. AIM To report the experience of a single tertiary center in the use of EUS and EUS-FNA in a pediatric population and to further assess its safety, feasibility, and clinical impact on management. METHODS A retrospective study of 13 children (aged 18 years or younger) identified from our medical database was conducted. A retrospective review of demographic data, procedure indications, EUS findings, and the clinical impact of EUS on the subsequent management of these patients was performed. RESULTS During the 4-year study period, a total of 13 (1.7%) pediatric EUS examinations out of 749 EUS procedures were performed in our unit. The mean age of these 8 females and 5 males was 15.6 years (range: 6-18). Six of the 13 EUS examinations were pancreatobiliary (46.1%), followed by mediastinal 2/13 (15.4%), peri-gastric 2/13 (15.4%), abdominal lymphadenopathy 1/13 (7.7%), tracheal 1/13 (7.7%) and rectal 1/13 (7.7%). Overall, EUS-FNA was performed in 7 patients (53.8%) with a diagnostic yield of 100%. The EUS results had a significant impact on clinical care in 10/13 (77%) cases. No complications occurred in these patients during or after any of the procedures. CONCLUSION EUS and EUS-FNA in the pediatric population are safe, feasible, and have a significant clinical impact on the subsequent management; thus avoiding invasive and unnecessary procedures.

EUS in Pediatrics: A Multicenter Experience and Review

“…Since the Bizzarri review, there have been at least two series published on EUS in pediatrics. These series, despite having slightly different goals, continue to show similar indications and a positive clinical impact (17,18).…”

Impact of Diagnostic and Interventional Endoscopic Ultrasonography in Children

“…However, there are fewer neoplastic diseases in children than adults (despite the increasing frequency of pancreatobiliary diseases among children) (5) . EUS-FNA has become an important tool for the histological or therapeutic diagnosis of gastrointestinal diseases (2,19,25) . D-EUS tends to replace endoscopic retrograde cholangiopancreatography as a diagnostic tool for pancreatobiliary diseases, both in adults and children.…”

“…EUS is a sensitive tool for studying the pancreas and bile ducts and detecting chronic pancreatitis due to the proximity of the pancreaticobiliary region to the stomach and duodenum, which facilitates a detailed evaluation by EUS (10) . This aspect and the ability to obtain tissue samples (EUS-FNA) are advantages over other imaging techniques (13,25) .…”

“…The role of EUS in adult populations has already been well established. However, assessment of its clinical impact in pediatric patients remains limited to some case series (12,25) . The present study represents one of the largest case series focusing on the efficacy and safety of D-EUS and I-EUS in pediatric patients, which has been associated with a significant clinical impact.…”

Endoscopic Ultrasound for Diagnosis and Management of Pediatric Gastrointestinal Stromal Tumor

“…However, a few studies report EUS and EUS-FNA for pediatric patients with suspected gastric tumors. In adult patients, EUS and EUS-FNA are a well-established techniques for an accurate diagnosis of a GIST ( 6 ). Several reports show that EUS and EUS-FNA in pediatric patients are safe, feasible and have a significant impact on the management of various disorders of the gastrointestinal tract ( 6 , 7 , 8 ).…”