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Recent progress and current status of pancreatobiliary interventional endoscopic ultrasound in children
Shigeto Ishii1, Hiroyuki Isayama1, Mitsuyoshi Suzuki2
1Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
Insights
Adult endoscopic ultrasound (EUS) scopes can be used in children, but require careful monitoring for adverse events. Training programs are needed to improve pediatric interventional EUS (I-EUS) skills.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Medical Imaging
Background:
- Endoscopic ultrasound (EUS) is increasingly recognized for its utility in pediatric patients.
- Currently, a dedicated pediatric EUS scope is unavailable; adult scopes are utilized.
- Existing guidelines offer some feasibility insights based on patient size.
Purpose of the Study:
- To evaluate the feasibility and considerations of using adult EUS scopes in pediatric patients.
- To discuss the safety, procedural settings, and training needs for pediatric interventional EUS (I-EUS).
Main Methods:
- Review of current practices and literature regarding pediatric EUS and I-EUS.
- Analysis of potential adverse events and necessary monitoring protocols.
- Comparison of procedural settings: general anesthesia (GA) in the operating room versus sedation in the endoscopy room.
Main Results:
- Adult EUS scopes are adaptable for pediatric use, necessitating vigilance for risks like esophageal perforation and airway compromise.
- Most interventional pancreatobiliary endoscopy devices are suitable for children.
- Sedation in the endoscopy room offers advantages in procedural efficiency and repetition compared to GA in the operating room.
- Adult pancreatobiliary endoscopists frequently perform pediatric I-EUS due to limited pediatric endoscopist experience.
Conclusions:
- Pediatric I-EUS is feasible using adult equipment with appropriate precautions and monitoring.
- Sedation in the endoscopy room may be preferable to GA for certain pediatric I-EUS procedures.
- Establishing dedicated training programs is crucial for advancing pediatric EUS expertise and practice.
Abstract:
In recent years, the usefulness of endoscopic ultrasound (EUS) has been recognized in children. A dedicated pediatric EUS scope has not been developed; in our experience, however, an adult EUS scope can be used. The American Society for Gastrointestinal Endoscopy Technical Committee status assessment report on pediatric endoscopy equipment provides some guidance on the feasibility of EUS according to body size. Careful monitoring is required, keeping in mind potential adverse events such as cervical esophageal perforation and unstable breathing due to tracheal compression. Most devices designed for interventional pancreatobiliary endoscopy are also available for children. Sedation or intubated general anesthesia (GA) is mandatory when performing interventional EUS (I-EUS). I-EUS for children is generally performed using GA in the operating room, but sedation in the endoscopy room is also possible under appropriate monitoring by pediatricians. I-EUS in the operating room is sometimes difficult for endoscopists to perform because of the unsuitable fluoroscopic imaging and the lack of familiar equipment and staff. Compared to GA, sedation in the endoscopy room facilitates easier and quicker repetition of procedures when necessary. Adult pancreatobiliary endoscopists perform most I-EUS procedures in the pediatric population because most pediatric endoscopists have few opportunities to perform EUS-related procedures and thus have difficulty maintaining their skills. To popularize I-EUS techniques for children, it will be necessary to establish a training program for developing pediatric endoscopists.
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