Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2022; 10(02): E192-E199
DOI: 10.1055/a-1675-2291
Original article

Usefulness of endoscopic ultrasound in children with pancreatobiliary and gastrointestinal symptoms

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
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

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.



Publication History

Received: 26 June 2021

Accepted: 23 August 2021

Article published online:
15 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Dhir V, Paramasivam RK, Lazaro JC. et al. The role of therapeutic endoscopic ultrasound now and for the future. Expert Rev Gastroenterol Hepatol 2014; 8: 775-791
    CrossrefPubMedGoogle Scholar
  • 2 Bizzarri B, Nervi G, Ghiselli A. et al. Endoscopic ultrasound in pediatric population: a comprehensive review of the literature. Acta Biomed 2018; 89: 33-39
    PubMedGoogle Scholar
  • 3 Fugazza A, Bizzarri B, Gaiani F. et al. 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
    CrossrefPubMedGoogle Scholar
  • 4 Mahajan R, Simon EG, Chacko A. et al. Endoscopic ultrasonography in pediatric patients--Experience from a tertiary care center in India. Indian J Gastroenterol 2016; 35: 14-19
    CrossrefPubMedGoogle Scholar
  • 5 Raina A, Conrad MA, Sahn B. et al. Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population. Endosc Ultrasound 2017; 6: 195-200
    CrossrefPubMedGoogle Scholar
  • 6 Varadarajulu S, Wilcox CM, Eloubeidi MA. Impact of EUS in the evaluation of pancreaticobiliary disorders in children. Gastrointest Endosc 2005; 62: 239-244
    CrossrefPubMedGoogle Scholar
  • 7 Al-Rashdan A, LeBlanc J, Sherman S. et al. Role of endoscopic ultrasound for evaluating gastrointestinal tract disorders in pediatrics: A tertiary care center experience. J Pediatr Gastroenterol Nutr 2010; 51: 718-722
    CrossrefPubMedGoogle Scholar
  • 8 Attila T, Adler DG, Hilden K. et al. EUS in pediatric patients. Gastrointest Endosc 2009; 70: 892-898
    CrossrefPubMedGoogle Scholar
  • 9 Bjerring OS, Durup J, Qvist N. et al. Impact of upper gastrointestinal endoscopic ultrasound in children. J Pediatr Gastroenterol Nutr 2008; 47: 110-113
    CrossrefPubMedGoogle Scholar
  • 10 Roseau G, Palazzo L, Dumontier I. et al. Endoscopic ultrasonography in the evaluation of pediatric digestive diseases: Preliminary results. Endoscopy 1998; 30: 477-481
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Dhir V, Adler DG, Pausawasdi N. et al. Feasibility of a complete pancreatobiliary linear endoscopic ultrasound examination from the stomach. Endoscopy 2018; 50: 22-32
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Yamao K, Irisawa A, Inoue H. et al. Standard imaging techniques of endoscopic ultrasound-guided fine-needle aspiration using a curved linear array echoendoscope. Dig Endosc 2007; 16: S180-S205
    PubMedGoogle Scholar
  • 13 Iwashita T, Yasuda I, Mukai T. et al. Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions: a single-center prospective pilot study (MOSE study). Gastrointest Endosc 2015; 81: 177-185
    CrossrefPubMedGoogle Scholar
  • 14 Dhir V, Bhandari S, Bapat M. et al. Comparison of EUS-guided rendezvous and precut papillotomy techniques for biliary access (with videos). Gastrointest Endosc 2012; 75: 354-359
    CrossrefPubMedGoogle Scholar
  • 15 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedGoogle Scholar
  • 16 Oh SH. Sedation in pediatric esophagogastroduodenoscopy. Clin Endosc 2018; 51: 120-128
    CrossrefPubMedGoogle Scholar
  • 17 De Castro VL, Moura EG, Chaves DM. et al. Endoscopic ultrasound versus magnetic resonance cholangiopancreatography in suspected choledocholithiasis: A systematic review. Endosc Ultrasound 2016; 5: 118-128
    CrossrefPubMedGoogle Scholar
  • 18 Kieling CO, Hallal C, Spessato CO. et al. Changing pattern of indications of endoscopic retrograde cholangiopancreatography in children and adolescents: a twelve-year experience. World J Pediatr 2015; 11: 154-159
    CrossrefPubMedGoogle Scholar
  • 19 Buxbaum JL, Abbas Fehmi SM. ASGE Standards of Practice Committee. et al. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gastrointest Endosc 2019; 89: 1075-1105
    CrossrefPubMedGoogle Scholar
  • 20 Domínguez-Munoz JE, Larino-Noia J, Alvarez-Castro A. et al. Endoscopic ultrasound-based multimodal evaluation of the pancreas in patients with suspected early chronic pancreatitis. United Eur Gastroenterol J 2020; 8: 790-797
    CrossrefPubMedGoogle Scholar
  • 21 Gong EJ, Kim DH. Endoscopic ultrasonography in the diagnosis of gastric subepithelial lesions. Clin Endosc 2016; 49: 425-433
    CrossrefPubMedGoogle Scholar
  • 22 Brecht IB, Graf N, Schweinitz D. et al. Networking for children and adolescents with very rare tumors: foundation of the GPOH Pediatric Rare Tumor Group. Klin Padiatr 2009; 221: 181-185
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Gervais DA, Ho CH, O'Neill MJ. et al. Recurrent abdominal and pelvic abscesses: incidence, results of repeated percutaneous drainage, and underlying causes in 956 drainages. AJR Am J Roentgenol 2004; 182: 463-466
    CrossrefPubMedGoogle Scholar
  • 24 vanSonnenberg E, Wittich GR, Goodacre BW. et al. Percutaneous abscess drainage: update. World J Surg 2001; 25: 362-369
    CrossrefPubMedGoogle Scholar
  • 25 Barth BA, Banerjee S. ASGE Technology Committee. et al. Equipment for pediatric endoscopy. Gastrointest Endosc 2012; 76: 8-17
    CrossrefPubMedGoogle Scholar
  • 26 Gress F, Michael H, Gelrud D. et al. EUS-guided fine-needle aspiration of the pancreas: evaluation of pancreatitis as a complication. Gastrointest Endosc 2002; 56: 864-867
    CrossrefPubMedGoogle Scholar
  • 27 Wang KX, Ben QW, Jin ZD. et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011; 73: 283-290
    CrossrefPubMedGoogle Scholar
  • 28 Ardengh JC, Taglieri E, Ardengh AO. et al. EUS-Guided Hotaxios for the treatment of traumatic pancreatic pseudocyst in pediatric patient. Arq Gastroenterol 2020; 57: 339-340
    CrossrefPubMedGoogle Scholar
  • 29 Ishii K, Itoi T, Tsuchiya T. et al. EUS-guided pancreatic duct rendezvous in a child with traumatic pancreatic duct disruption. Gastrointest Endosc 2014; 80: 519-520
    CrossrefPubMedGoogle Scholar
  • 30 Ito Y, Isayama H, Nakai Y. et al. Successful Endosonography-Guided Drainage of an Intra-Abdominal Abscess in a 1-Year-Old Infant. Gut Liver 2016; 10: 483-485
    PubMedGoogle Scholar
  • 31 Kouchi K, Yoshida H, Matsunaga T. et al. Endosonographic evaluation in two children with esophageal stenosis. J Pediatr Surg 2002; 37: 934-936
    CrossrefPubMedGoogle Scholar
  • 32 Cohen S, Kalinin M, Yaron A. et al. Endoscopic ultrasonography in pediatric patients with gastrointestinal disorders. J Pediatr Gastroenterol Nutr 2008; 46: 551-554
    CrossrefPubMedGoogle Scholar
  • 33 Scheers I, Ergun M, Aouattah T. et al. Diagnostic and therapeutic roles of endoscopic ultrasound in pediatric pancreaticobiliary disorders. J Pediatr Gastroenterol Nutr 2015; 61: 238-247
    CrossrefPubMedGoogle Scholar
  • 34 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
    CrossrefPubMedGoogle Scholar
  • 35 Raina A, Conrad MA, Sahn B. et al. Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population. Endosc Ultrasound 2017; 6: 195-200
    CrossrefPubMedGoogle Scholar
  • 36 Gordon K, Conway J, Evans J. et al. EUS and EUS-Guided Interventions Alter Clinical Management in Children with Digestive Diseases. J Pediatr Gastroenterol Nutr 2016; 63: 242-246
    CrossrefPubMedGoogle Scholar
  • 37 Singh SK, Srivastava A, Rai P. et al. Yield of Endoscopic Ultrasound in Children and adolescent with Acute Recurrent Pancreatitis. J Pediatr Gastroenterol Nutr 2018; 66: 461-465
    CrossrefPubMedGoogle Scholar
  • 38 Téllez-Ávila FI, Duarte-Medrano G, Herrera-Mora D. et al. Endoscopic ultrasound in pediatric patients with pancreatobiliary disease. Surg Laparosc Endosc Percutan Tech 2019; 29: 271-274
    CrossrefPubMedGoogle Scholar
  • 39 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
    CrossrefPubMedGoogle Scholar