|
1
|
Alomari O, Abualkhair KA, Saad K, Magdy S, Omran JA, AlSanafini MM, Hassan LA, ElBasatiny OY, Machane D, Abdulrahim M, Abo-Elmaged HG, Elshaieb M, Elfarargy MS, Elhoufey A, Dailah HG, Sayed AH, Ismail A, Walid B, Hashemy M, Afifi AM, Elgenidy A. Assessing the safety and effectiveness of endoscopic ultrasound for pediatric hepato-pancreatico-biliary disorders: a systematic review. Pediatr Radiol 2025; 55:215-225. [PMID: 39821667 DOI: 10.1007/s00247-024-06159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 12/20/2024] [Accepted: 12/28/2024] [Indexed: 01/19/2025]
Abstract
BACKGROUND Endoscopic ultrasound (US) has been established as a safe diagnostic tool for adults, but its use in children remains underexplored. The rising prevalence of pediatric hepato-pancreato-biliary disorders requires a closer examination of its utility. In this systematic review, we aimed to evaluate the efficacy, safety, and clinical impact of endoscopic US in the pediatric population, concentrating on its diagnostic accuracy and therapeutic applications. METHODS All related clinical studies were identified by searching the Web of Science databases, PubMed (MEDLINE), Scopus, Cochrane, and Embase. Data were extracted from relevant studies using a pre-planned Excel sheet. RESULTS Twenty-eight studies demonstrated that endoscopic US in children is safe, technically successful, and clinically impactful, offering valuable diagnostic and interventional competencies. Endoscopic US was frequently used for microlithiasis, choledocholithiasis, and pancreaticobiliary anomalies. It reliably outperformed other imaging modalities, effectively reducing the need for more invasive procedures. Endoscopic US had a remarkable clinical impact, with diverse diagnostic yields, highlighting its role in diagnosing and treating children with hepato-pancreato-biliary disorders. The safety profile of endoscopic US in children was excellent, with nominal reported complications. CONCLUSION Our comprehensive review underlines the promising application of endoscopic US in pediatric hepato-pancreato-biliary diseases. The endoscopic US demonstrates its diagnostic accuracy and therapeutic potential in children, offering a non-invasive, safe, and efficient approach. As we move forward, addressing the identified limitations and expanding the pediatric-specific research on endoscopic US will enhance our ability to provide precise and patient-centered care in managing pediatric hepato-pancreato-biliary disorders.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amira Elhoufey
- Assiut University, Assiut, Egypt
- Alddrab University College, Jazan University, Jazan, Saudi Arabia
| | | | | | | | | | | | - Ahmed M Afifi
- University of Texas MD Anderson Cancer Center, Houston, USA
| | | |
Collapse
|
|
2
|
Ishii S, Isayama H, Suzuki M, Koga H, Tomishima K, Fujisawa T, Shimizu T, Yamataka A. Recent progress and current status of pancreatobiliary interventional endoscopic ultrasound in children. Dig Endosc 2025; 37:53-67. [PMID: 39162053 DOI: 10.1111/den.14893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/04/2024] [Indexed: 08/21/2024]
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.
Collapse
Affiliation(s)
- Shigeto Ishii
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Mitsuyoshi Suzuki
- Department of Pediatrics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Hiroyuki Koga
- Department of Pediatric General and Urogenital Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ko Tomishima
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Toshio Fujisawa
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| |
Collapse
|
|
3
|
Bashir S, Loya A, Hussain M, Sheikh UN, Maqbool H, Yusuf MA. Utility of Endoscopic Ultrasound-Guided Fine-Needle Aspiration in a Paediatric Population: A Single-Centre Experience. Acta Cytol 2024; 68:397-404. [PMID: 39197434 DOI: 10.1159/000541140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 08/26/2024] [Indexed: 09/01/2024]
Abstract
INTRODUCTION Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a modern and minimally invasive technique to acquire diagnostic material from within the gastrointestinal tract, as well as from adjacent organs and structures, which can help in the diagnosis and staging of a variety of gastrointestinal malignancies, as well as for non-malignant conditions. Though well described in adults, there is limited literature on the diagnostic utility of EUS-FNA in paediatric patients. The objective of this study was to evaluate the diagnostic accuracy and clinical utility of EUS-FNA in paediatric patients performed at our centre over the last 17 years. MATERIALS AND METHODS After obtaining Institutional Review Board approval, 63 cases of paediatric EUS-FNA performed at SKMCH&RC from 2005 to 2022 were retrieved. A 22-gauge EUS-FNA needle was used for obtaining samples with the use of suction (when required). The sample was then smeared onto glass slides, with half being stained with RAPI stain while the rest with the Papanicolaou stain. Demographic details, indication for the procedure, results of rapid on-site adequacy status (ROSE), site of lesion, and cytological diagnosis were reviewed and analysed. RESULTS Of the 63 patients, 55 (87.3%) had an adequate sample (confirmed on ROSE). Forty-two (66.7%) were male and the mean age was 12.4 years. The most frequent indication of EUS-FNA was a sampling of enlarged lymph nodes (74.6%). The most common sites of nodal aspiration were sub-carinal (33.3%) and celiac lymph nodes (14.3%). EUS-FNA of a pancreatic lesion accounted for an additional 17.5% of cases. Involvement by Hodgkin's lymphoma was the most common diagnosis (25.4%) followed by granulomatous inflammation (19.1%). Cases of solid pseudo-papillary tumour (4.8%) and recurrent Wilm's tumour (3.2%) were also diagnosed. No patient suffered complications, and none required hospital admission, post-procedure. The sensitivity, specificity, PPV, and NPV of EUS-FNA were 98.1, 83.3, 96.4, and 90.9%, respectively. CONCLUSION EUS-FNA is a safe, well-tolerated, minimally invasive outpatient setting procedure with high sensitivity and significant utility in the diagnosis and staging of disease.
Collapse
Affiliation(s)
- Shaarif Bashir
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asif Loya
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Mudassar Hussain
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Umer Nisar Sheikh
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Hina Maqbool
- Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Muhammed Aasim Yusuf
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| |
Collapse
|
|
4
|
Krol BC, Rabinovich H, Wichelt N, Petty J, Linden M, McLean TW, Costa P. Endoscopic Ultrasound for Diagnosis and Management of Pediatric Gastrointestinal Stromal Tumor. JPGN REPORTS 2022; 3:e245. [PMID: 37168475 PMCID: PMC10158369 DOI: 10.1097/pg9.0000000000000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/21/2022] [Indexed: 05/13/2023]
Abstract
Gastrointestinal (GI) stromal tumors arise from the interstitial cells of Cajal and are rare in the pediatric population. The most common clinical manifestation is anemia secondary to GI bleeding. Endoscopy is commonly used for diagnostic and therapeutic interventions of an obstructing mass or gastrointestinal bleed, while experience with endoscopic ultrasound (EUS) and EUS fine needle aspiration (EUS-FNA) for pediatric patients with suspected gastric tumors is limited. We report 2 cases, a 14-year-old male and an 11-year-old female, who presented with symptomatic anemia. Both patients were diagnosed with GI stromal tumors of the stomach using EUS and EUS-FNA. This report shows that EUS and EUS-FNA are safe and effective diagnostic tools for pediatric patients.
Collapse
Affiliation(s)
| | - Hannah Rabinovich
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Natalie Wichelt
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - John Petty
- Department of Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Michael Linden
- Department of Pathology, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Thomas W. McLean
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Peter Costa
- Department of Pediatrics, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| |
Collapse
|
|
5
|
Garcia LL, Taglieri E, Micelli-Neto O, Ardengh JC. IMPACT OF DIAGNOSTIC AND INTERVENTIONAL ENDOSCOPIC ULTRASONOGRAPHY IN CHILDREN. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:456-461. [PMID: 36515337 DOI: 10.1590/s0004-2803.202204000-82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Endoscopic ultrasonography is used in the diagnosis and treatment of digestive diseases in adults. In children, its use is limited due to a lack of available expertise. OBJECTIVE This study aimed to evaluate the clinical impact of endoscopic ultrasonography on diagnostic and therapeutic strategy changes in pediatric patients. METHODS Over ten years, this study retrospectively and consecutively analyzed children aged ≤18 years who underwent endoscopic ultrasonography because of inconclusive imaging or laboratory tests. The indications, results, occurrence of adverse events, and clinical impact of the procedures were analyzed. The clinical impact was classified as major (when the findings led to changes in diagnosis and management), minor (change in diagnosis but not in management), or none (no change in diagnosis or management). RESULTS Overall, 107 children [77 (72%) of whom were female; mean age: 11.7 ± 4 years] underwent upper [102 (95.3%)] and lower [5 (4.7%)] endoscopic ultrasonography; 64 (58%) patients underwent diagnostic endoscopic ultrasonography, and 43 (42%) underwent interventional endoscopic ultrasonography. Endoscopic ultrasonography was used to investigate pancreaticobiliary, gastric, rectal, esophageal, duodenal, and mediastinal diseases in 81 (76%), 14 (13%), 5 (4.6%), 3 (2.8%), 2 (1.8%), and 2 (1.8%) patients, respectively. The clinical impact was significant in 81% of the children. Major and no clinical impact on pancreaticobiliary, gastrointestinal diseases, and mediastinal masses occurred in 50 (62%) and 13 (16%), 13 (54%) and 9 (37%), and 2 (100%) and 0 (0%) of the patients, respectively. CONCLUSION This study evaluated the impact of diagnostic and interventional endoscopic ultrasonography in pediatric patients. When clinically and appropriately indicated, these procedures are safe and effective diagnostic or therapeutic interventions in pediatric patients with gastrointestinal or pancreaticobiliary disorders.
Collapse
Affiliation(s)
| | - Eloy Taglieri
- Hospital Moriah, Serviço de Endoscopia, São Paulo, SP, Brasil
| | | | - José Celso Ardengh
- Hospital Moriah, Serviço de Endoscopia, São Paulo, SP, Brasil
- Universidade Federal de São Paulo, Departamento de Diagnóstico por Imagem, São Paulo, SP, Brasil
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), Setor de Endoscopia, Ribeirão Preto, São Paulo, SP, Brasil
| |
Collapse
|
|
6
|
Morphological and functional recovery following acute and acute recurrent pancreatitis in children: A prospective sequential 2-point evaluation. Pancreatology 2022; 22:698-705. [PMID: 35717306 DOI: 10.1016/j.pan.2022.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/13/2022] [Accepted: 06/03/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The functional and morphological recovery following an episode of acute pancreatitis (AP) in children still remains ill understood as research exploring this is limited. We aimed to characterize the morphological and functional changes in pancreas following AP and ARP (acute recurrent pancreatitis) in children. METHODS Children with AP were followed prospectively and assessed at two time points at least 3 months apart, with the first assessment at least 3 months after the AP episode. Exocrine and endocrine functions were measured using fecal elastase and fasting blood sugar/HbA1c levels respectively. Morphological assessment was done using endoscopic ultrasound (EUS) and magnetic resonance imaging and cholangiopancreatography (MRI/MRCP). RESULTS Seventy-three children (boys:59%; mean age:8.4 ± 3.2years) were studied and 21 of them (29%) progressed to ARP. Altered glucose homeostasis was seen in 19 (26%) at first and 16 (22%) at second assessment and it was significantly more in ARP group than the AP group at first (42.8%vs19.2%; p = 0.03) as well as second assessment (38.1%vs15.3%; p = 0.03). Twenty-one children (28.7%) at first and 24 (32.8%) at second assessment developed biochemical exocrine pancreatic insufficiency. EUS detected indeterminate and suggestive changes of chronic pancreatitis in 21% at first (n = 38) and 27.6% at second assessment (n = 58). On MRCP, main pancreatic duct and side branch dilatation were seen in 15 (20.5%) and 2 (2.7%) children respectively. CONCLUSIONS More than one-quarter of children have evidence of altered glucose homeostasis and biochemical exocrine pancreatic insufficiency following an episode of AP. Similarly, morphological features of chronicity seen in some of the children suggest that a fraction of subjects may develop chronic pancreatitis on longer follow-up.
Collapse
|
|
7
|
Dalal A, Kamat N, Patil G, Daftary R, Maydeo A. Usefulness of endoscopic ultrasound in children with pancreatobiliary and gastrointestinal symptoms. Endosc Int Open 2022; 10:E192-E199. [PMID: 35178337 PMCID: PMC8847054 DOI: 10.1055/a-1675-2291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/23/2021] [Indexed: 11/09/2022] Open
Abstract
Background and study aims Endoscopic ultrasound (EUS) is useful in diagnosing and treating childhood pancreatobiliary and gastrointestinal diseases. However, there are limited data on its effectiveness for various indications. Patients and methods This was a retrospective analysis of prospectively collected data of patients who underwent EUS for upper gastrointestinal tract disorders from January 2018 to December 2020 to assess its indications, findings, interventions, and complications. Results Ninety-two procedures were performed in 85 children, (70.5 % male; mean [SD] age 12.1 years [3.9] years) with a mean (SD) symptom duration of 1.1 (0.5) years. The procedures were technically successful in all patients. The primary indication for EUS was abdominal pain in 45(52.9%) and jaundice/cholangitis in 15 patients (17.6 %). General anesthesia was used in 12 (13 %) and TIVA in 80 patients (87 %). The most common diagnostic findings were choledocholithiasis in 21 (24.7 %) and cholelithiasis in 12 patients (14.1 %). Among interventions, EUS-guided cystogastrostomy for pancreatic pseudocyst was done in four patients (4.7 %), and EUS-guided rendezvous for failed ERCP in one patient (1.2 %) with cholangitis. There were no immediate post-procedural complications. Overall, EUS had a meaningful impact on the subsequent clinical management in 69 cases (81.2 %). Conclusions EUS in the pediatric population is safe, effective, and has a meaningful impact in appropriately selected cases. It can act as a rescue in major therapeutic procedures, but adequate care should be taken at the procedural level and during anesthesia.
Collapse
Affiliation(s)
- Ankit Dalal
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Nagesh Kamat
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Gaurav Patil
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Rajen Daftary
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| | - Amit Maydeo
- Baldota Institute of Digestive Sciences, Gleneagles Global Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
|
8
|
Nabi Z, Lakhtakia S, Chavan R, Asif S, Basha J, Gupta R, Yarlagadda R, Reddy PM, Kalapala R, Reddy DN. Diagnostic utility of EUS-guided tissue acquisition in children: A tertiary care center experience. Endosc Ultrasound 2021; 10:288-293. [PMID: 34213427 PMCID: PMC8411558 DOI: 10.4103/eus-d-20-00203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/23/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVES EUS is frequently utilized for tissue acquisition in adult patients. However, the literature is limited regarding the utility of EUS-guided fine-needle aspiration or biopsy (FNA or FNB) in children. In this study, we aim to evaluate the feasibility, safety, and diagnostic utility of EUS-FNA/FNB in children with various gastrointestinal diseases. METHODS The data of children (≤18 years) who underwent EUS-FNA/FNB from March 2014 to June 2020 were analyzed, retrospectively. The following parameters were analyzed: technical success, adverse events, and impact on the final diagnosis. RESULTS Sixty-seven children (32 - boys, 14.8 ± 2.9 years, range 8-18 years), underwent EUS-guided tissue acquisition procedures using standard therapeutic echoendoscope during the study period. The indications included solid pancreatic lesions in 29 (43.3%), mediastinal or abdominal lymphadenopathy in 30 (44.7%), cystic pancreatic lesions in 5 (7.5%), subepithelial lesions in 2 (3%), and retroperitoneal mass in 1 (1.5%). EUS-FNA and-FNB were performed in 42 and 25 children, respectively. All the procedures could be successfully performed and there was no major procedure-related adverse event. Minor adverse events included self-limiting throat pain (10) and abdominal pain (3), self-limited bleeding at puncture site (3), and transient fever (1). EUS-FNA/FNB provided a histopathological diagnosis in 59 (88.1%) children. CONCLUSION EUS-guided tissue acquisition using standard echoendoscope is feasible and safe in the pediatric age group. EUS-FNA/FNB establishes diagnosis in majority of the children when performed for appropriate clinical indication.
Collapse
Affiliation(s)
- Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Sundeep Lakhtakia
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Radhika Chavan
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Shujaath Asif
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Jahangeer Basha
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Rajesh Gupta
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Raghavendra Yarlagadda
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Palle Manohar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Rakesh Kalapala
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - D. Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| |
Collapse
|
|
9
|
Demirbaş F, Kaymazlı M, Çaltepe G, Abbasguliyev H, Kalaycı AG, Bektaş A. Endoscopic Ultrasonography in Pediatric Patients with Pancreatobiliary Disease: Single-Center Trial. Pediatr Gastroenterol Hepatol Nutr 2021; 24:164-172. [PMID: 33833972 PMCID: PMC8007838 DOI: 10.5223/pghn.2021.24.2.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/05/2020] [Accepted: 11/06/2020] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The use of Endoscopic ultrasonography (EUS) in pediatric patients is not as common as in adults. The aim of this study is to evaluate the role of EUS in the diagnosis of pancreatobiliary disease in childhood. METHODS Between December 2016 and January 2018, the findings of patients who underwent EUS were evaluated retrospectively. RESULTS Of the 41 patients included in the study 25 were girls (61.0%), mean age was 12.2±4.2 years. EUS was performed for biliary colic in 21 (51.2%), for recurrent pancreatitis in 12 (29.2%), for cholecystitis/cholangitis in 5 (12.2%), and for acute pancreatitis in 3 (7.4%) patients. EUS had a significant clinical effect in the decision of treatment and follow-up of 6/21 biliary colic cases, in diagnosis and follow-up of 6/12 recurrent pancreatitis cases, in decision-making and monitoring of invasive procedures (ERCP/surgery) of 3/5 acute cholecystitis/cholangitis and 2/3 of acute pancreatitis cases as well as in follow-up of the other cases. The effectiveness of EUS in determining direct treatment and invasive intervention was 43.9%. None of the patients had complications related to the EUS procedure. CONCLUSION Although current guidelines show that EUS can be used in pediatric patients, this is limited to a few published studies. In this study, it is shown that EUS is a safe method for the diagnosis, follow-up and treatment of common pancreatobiliary pathologies in childhood.
Collapse
Affiliation(s)
- Fatma Demirbaş
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Mustafa Kaymazlı
- Department of Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Gönül Çaltepe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | | | - Ayhan Gazi Kalaycı
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Ahmet Bektaş
- Department of Gastroenterology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| |
Collapse
|
|
10
|
Piester TL, Liu QY. EUS in Pediatrics: A Multicenter Experience and Review. Front Pediatr 2021; 9:709461. [PMID: 34513763 PMCID: PMC8424044 DOI: 10.3389/fped.2021.709461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
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.
Collapse
Affiliation(s)
- Travis L Piester
- Keck School of Medicine of the University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Quin Y Liu
- Cedars-Sinai Medical Center, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
|
11
|
Abstract
Despite the increased global recognition of pediatric pancreatic diseases, there are limited data on the utility of sophisticated endoscopic procedures such as endoscopic ultrasonography (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in their management. Promising results of recent studies have highlighted the emerging therapeutic utility of EUS and ERCP in children. With these latest developments in mind, this article reviews the current literature regarding diagnostic and therapeutic uses, benefits, limitations, and clinical outcomes of EUS and ERCP in pediatric pancreatology.
Collapse
|
|
12
|
Altonbary AY, Hakim H, Elkashef W. Role of endoscopic ultrasound in pediatric patients: A single tertiary center experience and review of the literature. World J Gastrointest Endosc 2020; 12:355-364. [PMID: 33133372 PMCID: PMC7579528 DOI: 10.4253/wjge.v12.i10.355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/18/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
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.
Collapse
Affiliation(s)
- Ahmed Youssef Altonbary
- Department of Gastroenterology and Hepatology, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura 35516, Egypt
| | - Hazem Hakim
- Department of Gastroenterology and Hepatology, Mansoura Specialized Medical Hospital, Mansoura University, Mansoura 35516, Egypt
| | - Wagdi Elkashef
- Department of Pathology, Mansoura University, Mansoura 35111, Egypt
| |
Collapse
|
|
13
|
The Roles of Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography in the Evaluation and Treatment of Chronic Pancreatitis in Children: A Position Paper From the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr 2020; 70:681-693. [PMID: 32332479 DOI: 10.1097/mpg.0000000000002664] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Pediatric chronic pancreatitis is increasingly diagnosed. Endoscopic methods [endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP)] are useful tools to diagnose and manage chronic pancreatitis. Pediatric knowledge and use of these modalities is limited and warrants dissemination. METHODS Literature review of publications relating to use of ERCP and EUS for diagnosis and/or management of chronic pancreatitis with special attention to studies involving 0--18 years old subjects was conducted with summaries generated. Recommendations were developed and voted upon by authors. RESULTS Both EUS and ERCP can be used even in small children to assist in diagnosis of chronic pancreatitis in cases where cross-sectional imaging is not sufficient to diagnose or characterize the disease. Children under 15 kg for EUS and 10 kg for ERCP can be technically challenging. These procedures should be done optimally by appropriately trained endoscopists and adult gastroenterology providers with appropriate experience treating children. EUS and ERCP-related risks both include perforation, bleeding and pancreatitis. EUS is the preferred diagnostic modality over ERCP because of lower complication rates overall. Both modalities can be used for management of chronic pancreatitis -related fluid collections. ERCP has successfully been used to manage pancreatic duct stones. CONCLUSION EUS and ERCP can be safely used to diagnose chronic pancreatitis in pediatric patients and assist in management of chronic pancreatitis-related complications. Procedure-related risks are similar to those seen in adults, with EUS having a safer risk profile overall. The recent increase in pediatric-trained specialists will improve access of these modalities for children.
Collapse
|
|
14
|
Endoscopic Ultrasound in Pediatric Patients With Pancreatobiliary Disease. Surg Laparosc Endosc Percutan Tech 2020; 29:271-274. [PMID: 31259867 DOI: 10.1097/sle.0000000000000673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is one of the greatest advances of the last few decades for the diagnostic and therapeutic approach of gastrointestinal diseases in adults. However, there are limitations to the application of the procedure in the pediatric population. The aim of this study was to describe the diagnostic yield and therapeutic role of EUS in pediatric patients with pancreatobiliary disease. MATERIALS AND METHODS A retrospective study was performed on a prospective database of pediatric patients who underwent diagnostic and therapeutic endosonographic procedures. All patients seen in a 12-year period were included. RESULTS A total of 54 patients were included, including 32 (59.3%) female individuals, with an average age of 16 (9 to 17) years. EUS was abnormal in 46 (85%) patients. Of the abnormal procedures, 4 (7.4%) corresponded to therapeutic ones. The main indication of the study was recurrent acute pancreatitis in 29 (54%). The main endosonographic findings were microlithiasis in 14 (25.9%), chronic pancreatitis in 9 (16.7%), and pancreatic tumors in 6 (11.1%) patients. Follow-up was performed in 31 (57.4%) patients, 19/31 patients underwent surgery, and 4/31 patients had endoscopic retrograde cholangiopancreatography. The median follow-up was 910 (2 to 3916) days. In 100% of the patients with follow-up, the initial diagnosis of EUS was confirmed. CONCLUSION EUS is a useful and safe tool in the pediatric population with pancreatobiliary diseases.
Collapse
|
|
15
|
Role of Diagnostic Endoscopic Ultrasound in Idiopathic Acute Pancreatitis and Acute Recurrent Pancreatitis in Children. Pancreas 2019; 48:350-355. [PMID: 30747822 DOI: 10.1097/mpa.0000000000001243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Endoscopic ultrasound (EUS) is a minimally invasive pancreatic imaging modality. We evaluated children with idiopathic acute pancreatitis (IAP) and acute recurrent pancreatitis (ARP) for changes of chronicity (Rosemont criteria) and biliary risk factors. Diagnostic yield of simultaneously performed transabdominal ultrasonography (TUS) was compared with EUS. METHODS This was a prospective observational study. Patients underwent EUS and TUS after 2 months of pancreatitis attack. RESULTS Forty-five (18 IAP, 27 ARP) patients underwent EUS and TUS. Mean (standard deviation) age and weight were 9.1 (2.6) years and 32.66 (12.43) kg in IAP, whereas these were 12.2 (3.1) years and 44.84 (15.12) kg in ARP, respectively. Endoscopic ultrasound demonstrated morphological abnormality in 33.3% and 40.7% of IAP and ARP, respectively (P = 0.61), whereas 16.6% and 25.9% were abnormal in TUS. Endoscopic ultrasound showed unequivocal changes of chronicity (11.1% vs 0%) and risk factors only among ARP (25.9% vs 0%; P = 0.03) and demonstrated slightly higher odds ratio (95% confidence interval) as compared with TUS to detect abnormalities in both IAP (2.43 [0.49-14.17], P = 0.28) and ARP (1.94 [0.60-6.47], P = 0.26). CONCLUSIONS Applying EUS, changes of chronicity and risk factors were noted only in ARP. Endoscopic ultrasound performed better than TUS in detecting chronicity.
Collapse
|
|
16
|
Bizzarri B, Nervi G, Ghiselli A, Manzali E, Di Mario F, Leandro G, Gaiani F, Kayali S, De' Angelis GL. Endoscopic ultrasound in pediatric population: a comprehensive review of the literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:33-39. [PMID: 30561393 PMCID: PMC6502188 DOI: 10.23750/abm.v89i9-s.7876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIM Endoscopic ultrasonography (EUS) with or without fine needle aspiration/biopsy (FNA/B) is a well-established diagnostic tool in adults for the evaluation and management of gastrointestinal (GI) tract disorders. Its use in children is still limited as well as literature in pediatric age is limited, although the application of EUS is now increasing. The present article aims to review the current literature about EUS indication, accuracy and safety in pediatric age. METHODS Electronic literature searches were conducted using Pubmed, Medline, Embase, and the Cochrane Central Register of Controlled Trials using the word pediatric endoscopic ultrasound, pediatric pancreaticobiliary AND/OR EUS, pediatric EUS technique. Main patients and procedures characteristics were analyzed. The primary endpoint was the indication of EUS. Secondary endpoints were the accuracy of the technique and the incidence of complications. RESULTS Data were extracted from 19 articles. A total of 571 patients were investigated, with a median age of 12,7 years. A total of 634 EUS procedures were performed. The majority of EUS procedures investigated the pancreaticobiliary tract (77,7%). Most studies showed a high positive impact on management with a median value of 81,7%. No major complications were reported. Five studies reported minor complications with a median value of 2%. CONCLUSIONS EUS is safe and has a significant role in the diagnosis of pancreaticobiliary and GI diseases even in children, with a high therapeutic success. An increasing EUS utilization by pediatric gastroenterologists is expected and offering dedicated EUS training to some selected pediatric gastroenterologists might be indicated.
Collapse
Affiliation(s)
- Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
|
17
|
Nabi Z, Reddy DN. Advanced Therapeutic Gastrointestinal Endoscopy in Children - Today and Tomorrow. Clin Endosc 2018; 51:142-149. [PMID: 29228523 PMCID: PMC5903083 DOI: 10.5946/ce.2017.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/02/2017] [Accepted: 09/09/2017] [Indexed: 02/07/2023] Open
Abstract
Gastrointestinal (GI) endoscopy plays an indispensable role in the diagnosis and management of various pediatric GI disorders. While the pace of development of pediatric GI endoscopy has increased over the years, it remains sluggish compared to the advancements in GI endoscopic interventions available in adults. The predominant reasons that explain this observation include lack of formal training courses in advanced pediatric GI interventions, economic constraints in establishing a pediatric endoscopy unit, and unavailability of pediatric-specific devices and accessories. However, the situation is changing and more pediatric GI specialists are now performing complex GI procedures such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography for various pancreatico-biliary diseases and more recently, per-oral endoscopic myotomy for achalasia cardia. Endoscopic procedures are associated with reduced morbidity and mortality compared to open surgery for GI disorders. Notable examples include chronic pancreatitis, pancreatic fluid collections, various biliary diseases, and achalasia cardia for which previously open surgery was the treatment modality of choice. A solid body of evidence supports the safety and efficacy of endoscopic management in adults. However, additions continue to be made to literature describing the pediatric population. An important consideration in children includes size of children, which in turn determines the selection of endoscopes and type of sedation that can be used for the procedure.
Collapse
Affiliation(s)
- Zaheer Nabi
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - Duvvur Nageshwar Reddy
- Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| |
Collapse
|
|
18
|
Yield of Endoscopic Ultrasound in Children and Adolescent With Acute Recurrent Pancreatitis. J Pediatr Gastroenterol Nutr 2018; 66:461-465. [PMID: 29216022 DOI: 10.1097/mpg.0000000000001855] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Endoscopic ultrasound (EUS) is an established tool for evaluation of adults with acute recurrent pancreatitis (ARP) whereas data in pediatrics is limited. Our study assessed the role of EUS in identifying etiology including changes of chronic pancreatitis (CP) in children and adolescents with ARP. METHODS Children with ARP (≥2 episodes of acute pancreatitis [AP]) were prospectively evaluated with a detailed clinical proforma and EUS. Subjects with known etiology of ARP or CP on ultrasonography/computed tomography and magnetic resonance cholangiopancreatography (MRCP, Cambridge grade ≥3) were excluded. Parenchymal and ductal changes on EUS as per minimal standards terminology (MST) features were noted. RESULTS Thirty-two children (22 boys, age 14 [8-18] years) with ARP (median of 3 [2-5] episodes of AP) were enrolled. EUS was safe and technically successful in all. Gall bladder sludge was found in 1 (3%) case and none had other pancreatobiliary structural abnormalities. EUS diagnosis of CP (≥4 features) was made in 10/32 (31%) cases. Subjects with CP on EUS had a longer disease duration than those without CP (45 [10-97] vs 22 [8-78] months; P = ns). MRCP was normal in 28 and showed pancreas divisum in 1 case. Three cases had equivocal (Cambridge II) changes at initial MRCP and 2 of them had repeat MRCP, which showed definite (Cambridge IV) CP. All these 3 cases had CP on EUS. CONCLUSIONS EUS diagnosed CP (≥4 features) in 31% and biliary abnormality in 3% children with ARP. EUS is safe, sensitive, and useful for early diagnosis of CP in children with ARP.
Collapse
|
|
19
|
Keane MG, Kumar M, Cieplik N, Thorburn D, Johnson GJ, Webster GJ, Chapman MH, Lindley KJ, Pereira SP. Paediatric pancreaticobiliary endoscopy: a 21-year experience from a tertiary hepatobiliary centre and systematic literature review. BMC Pediatr 2018; 18:42. [PMID: 29426291 PMCID: PMC5807847 DOI: 10.1186/s12887-017-0959-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/08/2017] [Indexed: 12/21/2022] Open
Abstract
Background In adults ERCP and endoscopic ultrasound (EUS) are standard methods of evaluating and treating many hepatopancreaticobiliary (HPB) conditions. HPB disease is being diagnosed with increasing frequency in children but information about role of ERCP and EUS and their outcomes in this population remain limited. Therefore the aims of this study were to describe the paediatric ERCP and EUS experience from a large tertiary referral HPB centre, and to systematically compare outcomes with those of other published series. Methods All patients <18 years undergoing an ERCP or EUS between January 1992–December 2014 were included. Indications for the procedure, rates of technical success, procedural adverse events and reinterventions were recorded in all cases. Results Ninety children underwent 111 procedures (87 ERCPs and 24 EUS). 53% (48) were female with a median age of 14 years (range: 3 months - 17 years). Procedures were performed under general anaesthesia (n = 48) or conscious sedation (n = 63). Common indications for ERCP included chronic or recurrent pancreatitis and biliary obstruction. Patients frequently had multiple comorbidities, with a median ASA grade of 2 (range 1–4). Therapeutic procedures performed included biliary or pancreatic sphincterotomy, common bile duct or pancreatic duct stone removal, biliary or pancreatic stent insertion, EUS-guided fine needle aspiration and endoscopic transmural drainage of pancreatic fluid collections. No adverse events were reported following ERCP but there was one complication requiring surgery following EUS guided cystenterostomy. Conclusion ERCP and EUS in children and adolescents have high technical success rates and low rates of adverse events when performed in high volume HPB centres.
Collapse
Affiliation(s)
- Margaret G Keane
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK
| | - Mayur Kumar
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - Natascha Cieplik
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK
| | - Douglas Thorburn
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK
| | - Gavin J Johnson
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - George J Webster
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - Michael H Chapman
- Department of Gastroenterology, University College of London Hospital, 235 Euston Road, London, NW1 2BG, UK
| | - Keith J Lindley
- Department of Gastroenterology, Great Ormond Street Hospital, London, WC1N 3JN, UK
| | - Stephen P Pereira
- Institute for Liver and Digestive Health, University College London, Royal Free Campus, Pond St, London, NW3 2PF, UK.
| |
Collapse
|
|
20
|
Fugazza A, Bizzarri B, Gaiani F, Manfredi M, Ghiselli A, Crafa P, Carra MC, de’Angelis N, de’Angelis GL. The role of endoscopic ultrasound in children with Pancreatobiliary and gastrointestinal disorders: a single center series and review of the literature. BMC Pediatr 2017; 17:203. [PMID: 29212476 PMCID: PMC5719791 DOI: 10.1186/s12887-017-0956-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 11/28/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of endoscopic ultrasound (EUS) in the management of pancreatobiliary and digestive diseases is well established in adults, but it remains limited in children. The aim of this study was to evaluate the feasibility, safety, and clinical impact of EUS use in children. METHODS This is a retrospective analysis of a prospectively acquired database of consecutive pediatric (< 18 years) patients presenting an indication for EUS for pancreatobiliary and gastrointestinal disorders. RESULTS Between January 2010 and January 2016, 47 procedures were performed in 40 children (mean age of 15.1 ± 4.7 years; range 3-18). The majority of EUS (n = 32; 68.1%) were performed for pancreatobiliary and upper gastrointestinal pathologies, including suspected common bile duct stones (CBDs), acute biliary pancreatitis, recurrent/chronic pancreatitis, cystic pancreatic mass, recurrent hypoglycemia, duodenal polyp, gastric submucosal lesion, and perigastric abscess. In only 2 out of 18 children with suspected CBDs or acute biliary pancreatitis, EUS confirmed CBDs. EUS-guided fine needle aspiration was performed in 3 (6.4%) patients. Fifteen (31.9%) procedures were performed for lower gastrointestinal tract disorders, including suspected anal Crohn's disease, fecal incontinence, and encopresis. Overall, EUS had a significant impact on the subsequent clinical management in 87.2% of patients. CONCLUSION The present findings were consistent with results observed in the current relevant literature and support EUS as a safe and feasible diagnostic and therapeutic tool, which yields a significant clinical impact in children with pancreatobiliary and gastrointestinal disorders.
Collapse
Affiliation(s)
- Alessandro Fugazza
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Barbara Bizzarri
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Marco Manfredi
- Department of Pediatrics, “Pietro Barilla” Children’s Hospital, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Alessia Ghiselli
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| | - Pellegrino Crafa
- Department of Pathology, University Hospital of Parma, 43126 Parma, Italy
| | | | - Nicola de’Angelis
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, 94010 Paris, Créteil France
- Cancer Research Lab. EC2M3, Université Paris-Est, Créteil, Val de Marne UPEC, 94010 Paris, France
| | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
| |
Collapse
|
|
21
|
Patel S, Marshak J, Daum F, Iqbal S. The emerging role of endoscopic ultrasound for pancreaticobiliary diseases in the pediatric population. World J Pediatr 2017; 13:300-306. [PMID: 28393319 DOI: 10.1007/s12519-017-0020-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 07/14/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) is a useful diagnostic and therapeutic tool in the pediatric population. Given the high accuracy and sensitivity of EUS, it is particularly effective in evaluating pancreaticobiliary disease. Published literature in the use of pediatric EUS is limited. Therefore we aimed to review the current literature for EUS indications, safety, and effectiveness for the pediatric population. DATA SOURCES English language articles on the use of pediatric endoscopic ultrasound in evaluating pancreaticobiliary diseases were retrieved from PubMed/ MEDLINE. RESULTS We analyzed various retrospective studies and case series publications. Data were extrapolated for pediatric patients with pancreaticobiliary diseases. CONCLUSIONS EUS offers superior imaging. It is comparible to magnetic resonance imaging and/or pancreatic-protocol computed tomography. In the current literature, there are a variety of pancreaticobiliary conditions where EUS was utilized to make a diagnosis. These include recurrent pancreatitis, congenital anomalies, microlithiasis, pancreatic pseudocysts, and pancreatic mass lesions. EUS was shown to be a safe and cost-effective modality with both diagnostic and therapeutic capabilities in the pediatric population. EUS is now increasingly being recognized as a standard of care when evaluating pancreaticobiliary conditions in children.
Collapse
Affiliation(s)
- Suril Patel
- Department of Internal Medicine, Winthrop University Hospital, 180 Hilton Ave, Apt #D1, Hempstead, NY, 11550, USA.
| | - Jarred Marshak
- Department of Internal Medicine, Winthrop University Hospital, 180 Hilton Ave, Apt #D1, Hempstead, NY, 11550, USA
| | - Fredric Daum
- Department of Pediatrics, Winthrop University Hospital, Hempstead, NY, USA
| | - Shahzad Iqbal
- Department of Internal Medicine, Winthrop University Hospital, 180 Hilton Ave, Apt #D1, Hempstead, NY, 11550, USA
| |
Collapse
|
|
22
|
Specialized Imaging and Procedures in Pediatric Pancreatology: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Clinical Report. J Pediatr Gastroenterol Nutr 2017; 64:472-484. [PMID: 28230608 DOI: 10.1097/mpg.0000000000001371] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed. METHODS We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: transabdominal ultrasonography (TUS), computed tomography (CT), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Recommendations for current use and future research were identified. RESULTS TUS offers noninvasive images of the pancreas but has limitations to details of parenchyma and ductal structures. CT offers improved detail of pancreatic parenchyma, solid masses, and traumatic injuries, but requires relatively high levels of ionizing radiation and does not adequately assess ductal anatomy. MRI/MRCP offers detailed intrinsic tissue assessment and pancreatic ductal characterization, but requires longer image acquisition time and is relatively poor at imaging calcifications. EUS provides excellent evaluation of pancreatic parenchyma and ductal anatomy, but can be subjective and operator dependent and requires sedation or anesthesia. EUS offers the capacity to obtain tissue samples and drain fluid collections and ERCP offers the ability to improve drainage by performing sphincterotomy or placing pancreatic stents across duct injuries and strictures. CONCLUSIONS Various imaging modalities may be used in pediatric pancreatology, but TUS and MRI/MRCP are favored. Interventional therapeutic maneuvers primarily involve use of ERCP and EUS. Future research is necessary to optimize equipment, expertise, and appropriate indications.
Collapse
|
|
23
|
Raina A, Conrad MA, Sahn B, Sedarat A, Ginsberg GG, Ahmad NA, Chandrasekhara V, Mamula P, Kochman ML. Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population. Endosc Ultrasound 2017. [PMID: 28621297 PMCID: PMC5488523 DOI: 10.4103/eus.eus_2_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background and Objectives: The safety and utility of endoscopic ultrasound (EUS) for the evaluation and management of gastrointestinal (GI) tract disorders among adults has been established. The literature on safety and efficacy in a pediatric referral population (under 21 years of age) is limited. We hypothesized that EUS is safe and useful in the pediatric population. We reviewed the pediatric EUS experience at a single tertiary-care system. We describe the indications, findings, safety, technical success rate, and impact on clinical outcomes. Patients and Methods: All patients 21 years of age or younger referred for EUS between 5, 2007 and 11, 2012 were identified from our electronic medical record databases. Retrospective chart review was then conducted to document demographics, procedure indications, procedure type (diagnostic or therapeutic), type of anesthesia used, EUS findings, and the clinical impact of EUS on the subsequent management of the patients. Results: Seventy EUS procedures were attempted in 58 patients during the study. Of these, two EUS procedures were aborted due to inadequate moderate sedation and 68 were successfully completed. The median age at initial endoscopy was 18 years (range 6–21 years), 50% were male and 65% were Caucasian. Four patients underwent EUS-guided pseudocyst drainage. Among the remaining 54 patients, the indications for EUS were the evaluation of GI mucosal/submucosal lesions (n = 14), acute or recurrent pancreatitis (n = 10), localization of suspected insulinoma (n = 8), evaluation of pancreatic abnormalities seen on prior imaging (n = 6), surveillance of tumors or evaluation of luminal lesions in hereditary syndromes (n = 6), abdominal pain of suspected pancreatobiliary origin (n = 5), and other rare indications (n = 5). Fine-needle aspiration was performed in 13 (9 diagnostic, 4 therapeutic) and trans-gastric fine-needle contrast injection of the pancreatic duct was performed in one patient without any complications. Sedation (data available for 66 procedures) included general endotracheal anesthesia in 38 (57%), monitored anesthesia care (MAC) in 19 (29%), and moderate sedation in 9 (14%). There were 4 minor intra-procedural anesthesia-related complications (laryngospasm in 2 and hypoxemia from airway obstruction and secretions in 2) in MAC and general endotracheal anesthesia (GA) cases, and 1 postprocedural complication (fever after pseudocyst drainage). EUS can achieve the diagnostic or therapeutic goal and ruled out suspected pathology in 88% of cases precluding need for additional testing. Conclusions: (1) EUS in the pediatric population is technically successful and efficacious. (2) Therapeutic and diagnostic EUS impacted clinical care decisions. (3) There is a low risk of immediate significant complications. (4) The overall efficacy and safety support the performance of EUS in a pediatric population by experienced endoscopists.
Collapse
Affiliation(s)
- Amit Raina
- Division of Gastroenterology and Hepatology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Maire A Conrad
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin Sahn
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alireza Sedarat
- Division of Gastroenterology and Hepatology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Gregory G Ginsberg
- Division of Gastroenterology and Hepatology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Nuzhat A Ahmad
- Division of Gastroenterology and Hepatology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Vinay Chandrasekhara
- Division of Gastroenterology and Hepatology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Petar Mamula
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael L Kochman
- Division of Gastroenterology and Hepatology, University of Pennsylvania Health System, Philadelphia, PA, USA
| |
Collapse
|
|
24
|
EUS and EUS-Guided Interventions Alter Clinical Management in Children With Digestive Diseases. J Pediatr Gastroenterol Nutr 2016; 63:242-6. [PMID: 26720768 DOI: 10.1097/mpg.0000000000001101] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Endoscopic ultrasound (EUS) ± fine needle aspiration (FNA) is a useful tool to evaluate gastrointestinal tract disorders in adults because of its established feasibility and safety. Its role in children has not been well established and continues to evolve. Our objective was to evaluate the utility and impact on clinical management of EUS and EUS-guided interventions in the pediatric population at our institution. METHODS Retrospective, single-center study including 43 patients undergoing EUS and EUS-FNA between August 2005 and January 2012. RESULTS Fifty-one EUS procedures were performed in 43 patients, 30 girls, median age 14.5 (range 4-18). The most common indications were suspected biliary obstruction in 11 of 51 (22%), pancreatic cysts in 10 of 51 (20%), acute or recurrent pancreatitis in 9 of 51 (18%), and abdominal pain in 8 of 51 (16%). The most common findings of EUS included normal 11 of 51 (22%), pancreas cyst 6 of 51 (12%), pancreatic pseudocyst 5 of 51 (10%), biliary system sludge or stones 9 of 51 (18%), and acute and chronic pancreatitis 5 of 51 (10%). EUS-FNA was performed in 13 cases: 7 solid masses or nodes, 4 pancreatic pseudocyst, 1 pancreatic cyst, and 1 celiac plexus block. FNA cyst drainage was successful in resolving all 4 pancreatic pseudocysts. EUS prompted a surgical procedure in 13 cases (25%), ERCP in 5 cases (10%), and repeat EUS in 5 cases (10%). EUS led to a new diagnosis in 34 of 43 (79%) patients and prompted further intervention in 24 of 51 (47%) procedures. CONCLUSIONS In this large cohort study, we found that EUS and EUS-guided interventions assist in diagnosing and altering clinical management in pediatric patients and should be considered in cases with vexing pancreaticobiliary disorders.
Collapse
|
|
25
|
Fishman DS, Chumpitazi BP, Raijman I, Tsai CMW, Smith EO, Mazziotti MV, Gilger MA. Endoscopic retrograde cholangiography for pediatric choledocholithiasis: Assessing the need for endoscopic intervention. World J Gastrointest Endosc 2016; 8:425-432. [PMID: 27298714 PMCID: PMC4896904 DOI: 10.4253/wjge.v8.i11.425] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/02/2016] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess pediatric patients for choledocholithiasis. We applied current adult guidelines to identify predictive factors in children.
METHODS: A single-center retrospective analysis was performed at a tertiary children’s hospital. We evaluated 44 consecutive pediatric patients who underwent endoscopic retrograde cholangiography (ERCP) for suspected choledocholithiasis. Patients were stratified into those with common bile duct stones (CBDS) at ERCP vs those that did not using the American Society of Gastrointestinal Endoscopy (ASGE) guidelines (Very Strong and Strong criteria) for suspected CBDS.
RESULTS: CBDS were identified in 84% at the time of ERCP. Abdominal ultrasound identified CBDS in 36% of patients. Conjugated bilirubin ≥ 0.5 mg/dL was an independent risk factor for CBDS (P = 0.003). The Very Strong (59.5%) and Strong (48.6%) ASGE criteria identified the majority of patients (P = 0.0001). A modified score using conjugated bilirubin had a higher sensitivity (81.2% vs 59.5%) and more likely to identify a stone than the standard criteria, odds ratio of 25.7 compared to 8.8. Alanine aminotransferase and gamma-glutamyl transferase values identified significant differences in a subset of patients with odds ratio of 4.1 and 3.25, respectively.
CONCLUSION: Current adult guidelines identified the majority of pediatric patients with CBDS, but specific pediatric guidelines may improve detection, thus decreasing risks and unnecessary procedures.
Collapse
|
|
26
|
Abstract
The application of endoscopic ultrasound (EUS) in children is growing, with studies demonstrating a positive impact of EUS in the management of childhood diseases. EUS has shown to be useful in the evaluation and management of a spectrum of childhood diseases including pancreaticobiliary disease, congenital anomalies, submuocsal lesions, biliary stones disease, inflammatory bowel disease, and eosinophilic esophagitis. Its diagnostic capabilities with fine-needle aspiration and core-needle biopsy are shown to be technically successful, safe, and effective in several pediatric studies. Therapeutic EUS procedures include endoscopic cystgastrostomy, celiac plexus neurolysis, and biliary access. This article discusses the role of EUS for diagnostic and therapeutic purposes in pediatrics.
Collapse
Affiliation(s)
- Arathi Lakhole
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #78, Los Angeles, CA 90027, USA
| | - Quin Y Liu
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Keck School of Medicine of USC, 4650 Sunset Boulevard, Mailstop #78, Los Angeles, CA 90027, USA.
| |
Collapse
|
|
27
|
Mahajan R, Simon EG, Chacko A, Reddy DV, Kalyan PR, Joseph AJ, Dutta AK, Chowdhury SD, Kurien RT. Endoscopic ultrasonography in pediatric patients--Experience from a tertiary care center in India. Indian J Gastroenterol 2016; 35:14-9. [PMID: 26946134 DOI: 10.1007/s12664-016-0619-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/11/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Although endoscopic ultrasound (EUS) is used in the management of various gastrointestinal (GI) diseases in adults, data on its role in children is limited. This study evaluated the indications, safety, and impact of EUS in children. METHODS Records of children (<18 years age) who underwent EUS between January 2006 and September 2014 were reviewed retrospectively and analyzed. RESULTS One hundred and twenty-one children (70 males, 51 females) aged 15.2 ± 2.9 years (mean ± SD) underwent 123 diagnostic (including fine needle aspiration cytology (FNAC) in 7) and 2 therapeutic EUS procedures. Conscious sedation was used in 81 procedures (65%) and general anesthesia in 44 (35%). The pancreaticobiliary system was evaluated in 114 (118 procedures), mediastinum in 5, and stomach in 2 patients. EUS diagnosed chronic pancreatitis (21 patients), pancreatic necrosis (1), splenic artery pseudoaneurysm (1), gastric varix (1), pseudocysts (3), insulinomas (2), other pancreatic masses (2), choledocholithiasis (2), choledochal cysts (2), portal biliopathy (1), esophageal leiomyoma (1), gastric neuroendocrine tumor (NET) (1), and GI stromal tumor in stomach (1). EUS-guided FNAC was positive in four of seven patients (two had tuberculosis, one pancreatic solid pseudopapillary tumor, and one gastric NET). Three patients had minor adverse events. EUS had a positive clinical impact in 43 (35.5%) patients. CONCLUSIONS EUS is feasible and safe in children. It provides valuable information that helps in their clinical management.
Collapse
Affiliation(s)
- Ramit Mahajan
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India.
| | - Ashok Chacko
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - D Viswanath Reddy
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - P Rupesh Kalyan
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - A J Joseph
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Amit Kumar Dutta
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Sudipta Dhar Chowdhury
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| | - Reuben Thomas Kurien
- Department of Gastroenterology, Christian Medical College, Vellore, 632 004, Tamil Nadu, India
| |
Collapse
|
|
28
|
Jia Y, Maspons A, Othman MO. The therapeutic use of endoscopic ultrasonography in pediatric patients is safe: A case series. Saudi J Gastroenterol 2015; 21:391-395. [PMID: 26655135 PMCID: PMC4707808 DOI: 10.4103/1319-3767.167191] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/17/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIM Despite the safety and high diagnostic yield of endoscopic ultrasound guided fine needle aspiration (EUS FNA) for the evaluation of gastrointestinal diseases in adults, literature discussing the therapeutic use of EUS FNA in pediatrics remains limited. This study reports our experience with the use of EUS in children with pancreaticobiliary disorders. PATIENTS AND METHODS A retrospective study was conducted to evaluate safety, clinical utility, and impact of therapeutic EUS on the management of children (<18 years) at a tertiary referral center. Data were collected from January 1, 2011, to April 30, 2014. Patient demographics, clinical characteristics, and EUS procedure data were reviewed. Continuous variables were described using the mean and standard deviation. Categorical variables were described using frequencies and percentages. RESULTS A total of 6 therapeutic EUS procedures were performed in 5 children (3 F/2 M). The mean age was 13 years (range 6-17) with a mean body mass index of 28.2 (range 18.5-38.8). The indications for EUS procedures were abdominal pain with chronic pancreatitis (3) and management of symptomatic pancreaticobiliary cysts/pseudocysts observed on previous imaging (3). All procedures were performed under general anesthesia. The 6 therapeutic procedures performed were celiac plexus block (3), cyst gastrostomy with stents placement (2), and cyst aspiration using EUS FNA (1). A celiac plexus block effectively relieved abdominal pain in 2 patients with chronic pancreatitis. Cyst gastrostomy successfully resulted in pseudocyst resolution in the follow up imaging of 2 patients (up to 6 months after the procedure). Cyst aspiration with EUS guided FNA resulted in cyst resolution and confirmation of the benign nature of the cyst in 1 patient. All the procedures were successfully completed with no reported complications. CONCLUSION The therapeutic use of endoscopic ultrasound in the pediatric population is safe and has a high success rate.
Collapse
Affiliation(s)
- Yi Jia
- Department of Gastroenterology, Texas Tech University Health Sciences Center, Texas, USA
| | - Aldo Maspons
- Department of Pediatrics, Texas Tech University Health Sciences Center, Texas, USA
| | - Mohammed O. Othman
- Department of Gastroenterology, Texas Tech University Health Sciences Center, Texas, USA
| |
Collapse
|
|
29
|
Diagnostic and Therapeutic Roles of Endoscopic Ultrasound in Pediatric Pancreaticobiliary Disorders. J Pediatr Gastroenterol Nutr 2015; 61:238-47. [PMID: 25564818 DOI: 10.1097/mpg.0000000000000692] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The diagnostic role of endoscopic ultrasound (EUS) in children has only recently been demonstrated, and that also to a lesser extent than in adults. Data on the technique's therapeutic indications remain scarce. We therefore sought to evaluate diagnostic and interventional EUS indications, safety, and impact in children with pancreaticobiliary disorders. METHODS We retrospectively reviewed our single pediatric center records, covering a 14-year period. RESULTS From January 2000 to January 2014, 52 EUS procedures were performed in 48 children (mean age: 12 years; range: 2-17 years) with pancreaticobiliary disorders for the following indications: suspected biliary obstruction (n = 20/52), acute/chronic pancreatitis (n = 20), pancreatic mass (n = 3), pancreatic trauma (n = 7), and ampullary adenoma (n = 2). EUS was found to have a positive impact in 51 of 52 procedures, enabling us to avoid endoscopic retrograde cholangiopancreatography (ERCP) (n = 13 biliary; n = 6 pancreatic), focusing instead on endotherapy (n = 7 biliary; n = 14 pancreatic) or reorienting therapy toward surgery (n = 7). EUS-guided fine-needle aspiration was carried out on 12 patients for pancreatic tumor (n = 4), pancreatic cyst fluid analysis (n = 4), autoimmune pancreatitis (n = 2), and suspicion of biliary tumor (n = 2). A total of 13 therapeutic EUS procedures (11 children) were conducted, including 9 combined EUS-ERCP procedures (7 children, mean age: 8 years, range: 4-11 years), 3 EUS-guided pseudocyst drainage (2 children), and 1 EUS-guided transgastric biliary drainage. CONCLUSIONS Our study reports on a large pediatric EUS series for diagnostic and therapeutic pancreaticobiliary disorders, demonstrating the impact of diagnostic EUS and affording insights into novel EUS and combined EUS-ERCP therapeutic applications. We suggest considering EUS as a diagnostic and therapeutic tool in the management of pediatric pancreaticobiliary diseases.
Collapse
|
|
30
|
Johal AS, Khara HS, Maksimak MG, Diehl DL. Endoscopic ultrasound-guided liver biopsy in pediatric patients. Endosc Ultrasound 2014; 3:191-194. [PMID: 25184126 PMCID: PMC4145480 DOI: 10.4103/2303-9027.138794] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/12/2014] [Indexed: 01/12/2023] Open
Abstract
Endoscopic ultrasound (EUS) is routinely used for diagnostic and therapeutic purposes in adults, and there is emerging literature on its feasibility and safety in children. A recent novel application is EUS-guided liver biopsy (EUS-LB), which has shown to be technically simple, safe, and provides adequate diagnostic yield in adults for evaluation of liver disease; but the use of EUS-LB has never been evaluated in the pediatric population. We report the first case series of EUS-LB in the pediatric population, performed on 3 children, 1 girl and 2 boys-ages 9, 14 and 17 respectively, using a 19-gauge EUS-fine needle aspiration needle. All three cases were performed for the evaluation of unexplained elevated liver enzymes, with above-average diagnostic yield and without any immediate or delayed complications in all children. The use of EUS-LB was pivotal in the management of all the cases. Our case series illustrates the diagnostic utility and safety of EUS-LB in pediatric patients.
Collapse
Affiliation(s)
- Amitpal S. Johal
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Harshit S. Khara
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Martin G. Maksimak
- Department of Pediatric Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - David L. Diehl
- Department of Gastroenterology, Geisinger Medical Center, Danville, Pennsylvania, USA
| |
Collapse
|
|
31
|
Sharma M, Wani ZA, Bansal R, Hari RS. Utility of Narrow Caliber Echo-bronchoscope in Pre-school Pediatric Population: A case series (with video). Endosc Ultrasound 2014; 2:96-101. [PMID: 24949372 PMCID: PMC4062243 DOI: 10.4103/2303-9027.117695] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 03/12/2013] [Indexed: 12/15/2022] Open
Abstract
The practical use of EUS in small children below the age of 4 years is not described. The aim of the study was to evaluate the feasibility, safety, and clinical utility of smaller caliber echo-bronchoscope in the management of gastrointestinal, pancreatobiliary, and mediastinal disease in children below 4 years. Consecutive children of age younger than 4 years where EUS was clinically considered useful were evaluated by echo-bronchoscopes. The findings showed that EUS by echo-bronchoscopes is feasible and safe in young children.
Collapse
Affiliation(s)
- Malay Sharma
- Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | | | - Raghav Bansal
- Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Ruth Shifa Hari
- Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| |
Collapse
|
|
32
|
Iwama I, Chinen K, Kato S, Kikuchi K. A pediatric case of pancreaticobiliary maljunction demonstrated by endoscopic ultrasonography. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
|
33
|
Liu QY, Nguyen V. Endoscopic approach to the patient with congenital anomalies of the biliary tract. Gastrointest Endosc Clin N Am 2013; 23:505-18. [PMID: 23540973 DOI: 10.1016/j.giec.2012.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Congenital biliary tract anomalies typically present with neonatal cholestasis. In children and adults, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound are used to evaluate and treat choledochal cysts. Contrarily, endoscopy has traditionally played a minor role in the diagnosis of the cholestatic infant. Recent studies support the incorporation of ERCP into the diagnostic algorithm for biliary atresia and neonatal cholestasis. But at present, most pediatric liver centers do not consider its use essential. This article reviews the congenital biliary tract anomalies in which endoscopy has been shown to contribute to the evaluation of the cholestatic infant.
Collapse
Affiliation(s)
- Quin Y Liu
- Keck School of Medicine, University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
| | | |
Collapse
|
|
34
|
Banerjee N, Adler DG. Endoscopic ultrasound in pediatric patients. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2013. [DOI: 10.1016/j.tgie.2012.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
|
35
|
Lin TK, Barth BA. Endoscopic retrograde cholangiopancreatography in pediatrics. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2013. [DOI: 10.1016/j.tgie.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
|
36
|
Curcio G, Pisa MD, Miraglia R, Catalano P, Barresi L, Tarantino I, Granata A, Spada M, Traina M. Case of obscure-overt gastrointestinal bleeding after pediatric liver transplantation explained by endoscopic ultrasound. World J Gastrointest Endosc 2012; 4:571-4. [PMID: 23293728 PMCID: PMC3536855 DOI: 10.4253/wjge.v4.i12.571] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 11/07/2011] [Accepted: 04/27/2012] [Indexed: 02/05/2023] Open
Abstract
Portal hypertension, which is a common finding in children awaiting liver transplantation, is also found after transplantation. It’s reported the case of a 6-year-old girl, transplanted for biliary atresia, who had a severe obscure-overt bleeding presenting with melena. An esophagogastroduodenoscopy showed several duodenal small, bulging lesions, with some red signs. Near the lesions, a depressed area of 2 cm, covered with mixed hyperemic and white mucosa, was observed. To better evaluate these lesions, we performed an endoscopic ultrasonography (EUS) that showed multiple, round hypoechoic areas 0.5-5 mm in diameter, compatible with duodenal varices, and several periduodenal anechoic lesions compatible with collaterals. A consecutive computed tomography scan showed a stenosis of the portal vein anastomosis confirmed with a transhepatic portography, which was successfully treated with balloon angioplasty. No further episodes of bleeding were observed during the follow-up. This case report suggests that EUS is safe and feasible in young children when using echoendoscopes designed for use in adults. However further studies are needed to validate the employment of this technique in the management and follow-up of pediatric portal hypertension.
Collapse
Affiliation(s)
- Gabriele Curcio
- Gabriele Curcio, Marta Di Pisa, Luca Barresi, Ilaria Tarantino, Antonino Granata, Mario Traina, Department of Gastroenterology, Liver Transplantation Unit, IsMeTT, 90100 Palermo, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
|
37
|
Jenssen C, Alvarez-Sánchez MV, Napoléon B, Faiss S. Diagnostic endoscopic ultrasonography: Assessment of safety and prevention of complications. World J Gastroenterol 2012; 18:4659-76. [PMID: 23002335 PMCID: PMC3442204 DOI: 10.3748/wjg.v18.i34.4659] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
Endoscopic ultrasonography (EUS) has gained wide acceptance as an important, minimally invasive diagnostic tool in gastroenterology, pulmonology, visceral surgery and oncology. This review focuses on data regarding risks and complications of non-interventional diagnostic EUS and EUS-guided fine-needle biopsy (EUS-FNB). Measures to improve the safety of EUS und EUS-FNB will be discussed. Due to the specific mechanical properties of echoendoscopes in EUS, there is a low but noteworthy risk of perforation. To minimize this risk, endoscopists should be familiar with the specific features of their equipment and their patients’ specific anatomical situations (e.g., tumor stenosis, diverticula). Most diagnostic EUS complications occur during EUS-FNB. Pain, acute pancreatitis, infection and bleeding are the primary adverse effects, occurring in 1% to 2% of patients. Only a few cases of needle tract seeding and peritoneal dissemination have been reported. The mortality associated with EUS and EUS-FNB is 0.02%. The risks associated with EUS-FNB are affected by endoscopist experience and target lesion. EUS-FNB of cystic lesions is associated with an increased risk of infection and hemorrhage. Peri-interventional antibiotics are recommended to prevent cyst infection. Adequate education and training, as well consideration of contraindications, are essential to minimize the risks of EUS and EUS-FNB. Restricting EUS-FNB only to patients in whom the cytopathological results may be expected to change the course of management is the best way of reducing the number of complications.
Collapse
|
|
38
|
EUS-FNA for a Pancreatic Neuroendocrine Tumor in a Four-Year-Old Daughter of a Woman Exposed to Radiation at Chernobyl. Case Rep Gastrointest Med 2012; 2012:462139. [PMID: 22762002 PMCID: PMC3384900 DOI: 10.1155/2012/462139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 04/18/2012] [Indexed: 01/29/2023] Open
Abstract
Pancreatic neoplasms in children are rare. Herein is reported the case of a four-year-old girl whose mother was exposed to radiation at Chernobyl that presented with obstructive jaundice and a mass suspected on CT and diagnosed by endoscopic ultrasound (EUS) with fine needle aspiration (FNA). This child is probably the youngest case of application of linear EUS with biopsy to be described. The diagnosis, management, and followup of children with this rare tumor are discussed.
Collapse
|
|
39
|
Jazrawi SF, Barth BA, Sreenarasimhaiah J. Efficacy of endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population. Dig Dis Sci 2011; 56:902-8. [PMID: 20676768 DOI: 10.1007/s10620-010-1350-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 07/12/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND While pancreatitis is uncommon in children, pseudocyst development can be a serious complication. Endoscopic drainage of pseudocysts is well established in adults. However, there are limited data regarding this procedure in a pediatric population. The objective of this study is to determine the safety and efficacy of endoscopic ultrasound-guided pseudocyst drainage in children. METHODS The study group included children (age <18 years) who presented for endoscopic drainage of symptomatic pancreatic pseudocysts in whom endoscopic ultrasound (EUS) was performed. In those cases with EUS guidance, a 19-gauge needle was used to access the pseudocyst and place a guidewire under fluoroscopic visualization. Needle-knife diathermy and balloon dilation of the tract were performed with subsequent placement of double pig-tailed stents for drainage. RESULTS Ten children with mean age of 11.8 years (range 4-17 years) were analyzed for pancreatic pseudocysts due to biliary pancreatitis (n = 4), trauma (n = 2), familial pancreatitis (n = 1), idiopathic pancreatitis (n = 2), and pancreas divisum (n = 1). In eight cases, EUS-guided puncture and stent placement was successful. In the remaining two cases, aspiration of cyst fluid until complete collapse was adequate. As experience increased with EUS examination in children, the therapeutic EUS scope alone was used in 50% of cases for the entire procedure. In all ten cases, successful transgastric endoscopic drainage of pseudocysts was achieved. CONCLUSIONS Endoscopic drainage of symptomatic pancreatic pseudocysts can be achieved safely in children. EUS guidance facilitates optimal site of puncture as well as placement of transmural stents.
Collapse
Affiliation(s)
- Saad F Jazrawi
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd. MC 9083, Dallas, TX 75390-9151, USA
| | | | | |
Collapse
|
|
40
|
Role of endoscopic ultrasound for evaluating gastrointestinal tract disorders in pediatrics: a tertiary care center experience. J Pediatr Gastroenterol Nutr 2010; 51:718-22. [PMID: 20683206 DOI: 10.1097/mpg.0b013e3181dac094] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Endoscopic ultrasound (EUS) with or without fine needle aspiration (FNA) has a well-established role in the evaluation of various gastrointestinal (GI) tract disorders in adults. The clinical impact of EUS on the management of the pediatric population remains less clear. This study evaluates the feasibility, safety, and applications of EUS ± FNA in pediatric GI tract disorders. PATIENTS AND METHODS Using a prospectively maintained EUS database, all patients 18 years of age or younger referred for EUS at our institution were identified. Retrospective chart review was conducted to document procedure indications, type of anesthesia used, EUS findings, final FNA cytology results, and clinical impact of EUS ± FNA on the subsequent management of pediatric patients. RESULTS Fifty-eight EUS procedures were performed in 56 patients (35 girls). Median age was 16 years (range 4-18 years). The main indications for EUS were acute or recurrent pancreatitis, abdominal pain of suspected pancreatobiliary origin, suspected biliary obstruction, upper GI mucosal/submucosal lesions, and evaluation of pancreatic abnormalities seen on prior imaging. Sedation used included nurse-administered propofol sedation in 38 (73%), general anesthesia in 9 (17%), and fentanyl with meperidine in 3 (6%). Five therapeutic procedures performed included celiac plexus blocks in 4 and 1 EUS-guided pancreatogram. In 44 (86%) patients, EUS provided a new diagnosis. The procedure was successfully completed in all patients with no reported complications. CONCLUSIONS EUS ± FNA is feasible and safe and makes a significant impact on most pediatric patients. Nurse-administered propofol sedation appears to be safe and well tolerated in this group.
Collapse
|
|
41
|
Attila T, Adler DG, Hilden K, Faigel DO. EUS in pediatric patients. Gastrointest Endosc 2009; 70:892-8. [PMID: 19577744 DOI: 10.1016/j.gie.2009.04.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 04/10/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND The knowledge of EUS use in children is limited. OBJECTIVE We investigated the indications, feasibility, safety, and clinical utility of EUS in the management of pediatric GI, pancreatobiliary, and mediastinal diseases. DESIGN Retrospective study. SETTING Two tertiary referral university hospitals. PATIENTS Consecutive children age younger than 18 years referred over a 7-year period for EUS evaluation. RESULTS Forty EUS scans were performed in 38 children with a mean age of 13.5 years. The indications for pancreatobiliary endosonography were pancreatitis (n = 10), solid pancreatic mass (n = 7), cystic pancreatic mass (n = 1), cyst in the setting of chronic pancreatitis (n = 1), suspected annular pancreas (n = 1), celiac plexus block (n = 1), suspected common bile duct stone (n = 1), abdominal pain and atrophic pancreas (n = 1), ampullary adenoma (n = 1), and abnormal MRCP in a patient with jaundice (n = 1). The indications for gastric EUS were mucosal lesions (n = 2) and subepithelial lesions (n = 4). The indications for mediastinal endosonography were mediastinal masses/lymph nodes (n = 5). The remaining evaluations were performed for esophageal stricture (n = 1), unexplained abdominal pain (n = 1), unexplained abdominal pain with celiac axis block (n = 1), and perirectal fluid collection (n = 1). EUS-guided FNA (EUS-FNA) was performed in 12 (30%) cases and established the correct diagnosis in 9 (75%). EUS-guided fine-needle injections for celiac axis block were performed in 2 (5%) cases. The procedure was successful in all patients, and no complications related to sedation, EUS, or EUS-FNA were encountered. LIMITATION Retrospective study. CONCLUSION EUS and EUS-FNA are feasible and safe and have a significant impact on the management of pediatric GI, pancreatobiliary, and mediastinal diseases.
Collapse
Affiliation(s)
- Tan Attila
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon 97239-3098, USA
| | | | | | | |
Collapse
|