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EUS in Pediatrics: A Multicenter Experience and Review
Travis L Piester1, Quin Y Liu2
1Keck School of Medicine of the University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, United States.
Insights
Endoscopic ultrasound (EUS) is a safe and effective diagnostic and therapeutic tool for pediatric patients. This study highlights its successful application in managing various gastrointestinal and pancreaticobiliary conditions in children.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Diagnostic Imaging
Background:
- Endoscopic ultrasound (EUS) is a recognized diagnostic and therapeutic modality in adult medicine.
- Pediatric EUS has demonstrated safety and efficacy, with expanding applications.
- This study reviews EUS experience in pediatric tertiary care centers.
Purpose of the Study:
- To evaluate the safety, technical success, and clinical impact of EUS in pediatric patients.
- To discuss current and emerging diagnostic and therapeutic uses of EUS in pediatric gastroenterology.
- To explore EUS applications in pancreaticobiliary diseases, congenital anomalies, eosinophilic esophagitis, inflammatory bowel disease, and liver disease.
Main Methods:
- Retrospective review of EUS procedures performed by pediatric gastroenterologists between April 2017 and November 2020.
- Data collected included patient demographics, procedure indications, technical success, and complications.
- A literature review was conducted to assess current and future pediatric EUS applications.
Main Results:
- Ninety-eight EUS procedures were performed, with 15.3% involving fine needle aspiration/biopsy and 9.2% being therapeutic.
- Common indications included choledocholithiasis (31.6%), pancreatic fluid collections (18.4%), and pancreatitis (14.3% each for chronic/recurrent and acute characterization).
- All 98 cases (100%) were technically successful with minimal complications, including one instance of post-procedure GI bleeding.
Conclusions:
- EUS is a safe and highly successful procedure in the pediatric population when performed by trained pediatric endosonographers.
- The study supports the expanded use of EUS in pediatric practice for a diverse range of indications.
- EUS shows significant potential for future development in pediatric gastroenterology, including therapeutic interventions.
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.
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