Safety and efficacy of endoscopic ultrasound as a diagnostic and therapeutic tool in pediatric patients: a multicenter study

Abstract

Background: Despite the well-established diagnostic and therapeutic applications of endoscopic ultrasound (EUS) in adults, data about its use in children are limited. In this study, we tried to assess the feasibility, safety, and clinical impact of EUS in pediatric patients. Methods: Data of pediatric patients (<18 years) referred for EUS over a 3-year period to the endoscopy units of four Egyptian tertiary centers were retrospectively analyzed. Significant impact was defined as a new diagnosis or treatment attributed to the EUS procedure. Results: Twenty-four diagnostic and five therapeutic EUS procedures were conducted in 29 children with a median age of 9 years. Indications for EUS included assessment of solid pancreatic mass ( n = 3), pancreatic cyst ( n = 2), suspected chronic pancreatitis ( n = 9), pancreatic pseudocyst (PPC) ( n = 5), recurrent hypoglycemia ( n = 1), bile duct mass ( n = 1), subepithelial lesion (esophageal, duodenal or anorectal) ( n = 4), mediastinal mass ( n = 1), pelvic mass ( n = 3), and mass at splenic hilum ( n = 1). Therapeutically, five patients underwent cystogastrostomy for symptomatic PPC with 100% technical and clinical success. EUS was able to diagnose 21 out of the other 24 patients. EUS-guided tissue acquisition was performed in 11 patients with definitive histopathological diagnosis in 10 patients (91%). There was no procedure-related major complication, while minor complications occurred in two cases (transient pain in one case, temporary fever, and vomiting in two cases). Conclusion: Standard linear EUS equipment and accessories can be used safely and effectively in selected pediatric patients for diagnostic and therapeutic purposes.

Surgical and Endoscopic Intervention for Chronic Pancreatitis in Children: The Kings College Hospital Experience

“…Endoscopic ultrasound (EUS) has gained increased popularity in recent years in the paediatric population [32][33][34][35][36], following its first report in 1998 on a series of 18 children from the Cochin Hospital, Paris [37]. EUS has been shown to be more sensitive at diagnosing anatomical variations and radiolucent stones in the pancreatobiliary system and can even evaluate CP earlier, in terms of disease progression, than MRCP [38,39].…”

Endotherapy in pediatric pancreatitis

“…Watchful waiting is recommended for large collections, but when spontaneous resolution is not anticipated EUS-guided drainage has become first line across many pediatric centers and often saves children from more invasive percutaneous approaches by general surgery or interventional radiology [11]. Reported technical success ranges from 95% to 100% [11,24 ▪▪ ,25,26 ▪ ]. Adverse event rates are low but not insignificant.…”

Endoscopic Point of Care Ultrasound: Foundations, Present Applications, Future Potentials

“…Seven cases were described with fine needle aspiration and EUS changed the diagnosis or therapy in 14 (44%) 10 . In the last few years, there have been multiple reports describing larger single center EUS experiences in children by pediatric gastroenterologists (see table) [11][12][13][14][15][16][17][18] . The table illustrates that in most series the vast majority of applications would be considered endoscopic Point of Care Ultrasound (E-POCUS) and that the indications are similar to the earlier studies mentioned above.…”