3568 Is endoscopic ultrasound useful during pediatric practice? preliminary report in venezuela.

Abstract

Today Endoscopic Ultrasound (EUS) plays an important role in gastrointestinal algorithm of benign and malignant diseases. In adults, it has shown to be complementary with abdominal ultrasound, computed tomography and ERCP for gastric and pancreatobiliary pathologies. However, there is little experience published about EUS in pediatric population.AIM OF THE STUDY: To determine EUS utility in a pediatric group of patients. PATIENTS AND METHODS: Between March and November 1999, 14 children, 8 girls and 6 boys, mean age 12.5 years (range 1.5-18 years), underwent an EUS by the same operator with an Olympus UM 30 GIF 20 or 130 echoendoscope, during conventional sedation (midazolan and or meperidine) or propofol in children under 5 years old (with anestesiologist present in the room). Patients had the following initial diagnosis: 5 acute recurrent pancreatitis (ARP), 3 submucosal tumors, 3 extrahepatic cholestasis, 2 acute pancreatitis, 1 Zollinger-Ellison syndrome. All pts underwent ERCP when it was requiere as a gold standard RESULTS: EUS showed the etiology in 3/5 pts with ARP, two with changes of chronic pancreatitis (>5 criteria, 1 with normal ERCP and 1 with abnormal ERCP and anomalous biliopancreatic junction ), and one pt with a subpapilar duodenal duplication cyst confirmed by ERCP and treated endoscopically. Two pts had a normal EUS and ERCP. EUS showed in 3 pts with submucosal tumors diagnosed by gastroscopy and normal biopsies: 1 lipoma, 1 ectopic pancreas and 1 bronchogenic cyst. 3 patients with extrahepatic cholestasis (two with normal conventional US) had gallblladder minilithiasis with normal CBD. 2 patients with acute pancreatitis showed at EUS gallbladder minilithiasis with normal CBD. All five patients avoided diagnostic ERCP with a normal resolution. One patient with Zollinger-Ellison syndrome showed a normal pancreatic body and tail, without a head evaluation due to surgical history and the gastrinoma remains unlocated. CONCLUSIONS: EUS is a safe and effective complementary method for gastrointestinal pediatric pathologies. EUS can identify etiologies after rutine explorations and avoid diagnostic ERCP, and ES should be use has a therapeutic procedure. Today Endoscopic Ultrasound (EUS) plays an important role in gastrointestinal algorithm of benign and malignant diseases. In adults, it has shown to be complementary with abdominal ultrasound, computed tomography and ERCP for gastric and pancreatobiliary pathologies. However, there is little experience published about EUS in pediatric population.AIM OF THE STUDY: To determine EUS utility in a pediatric group of patients. PATIENTS AND METHODS: Between March and November 1999, 14 children, 8 girls and 6 boys, mean age 12.5 years (range 1.5-18 years), underwent an EUS by the same operator with an Olympus UM 30 GIF 20 or 130 echoendoscope, during conventional sedation (midazolan and or meperidine) or propofol in children under 5 years old (with anestesiologist present in the room). Patients had the following initial diagnosis: 5 acute recurrent pancreatitis (ARP), 3 submucosal tumors, 3 extrahepatic cholestasis, 2 acute pancreatitis, 1 Zollinger-Ellison syndrome. All pts underwent ERCP when it was requiere as a gold standard RESULTS: EUS showed the etiology in 3/5 pts with ARP, two with changes of chronic pancreatitis (>5 criteria, 1 with normal ERCP and 1 with abnormal ERCP and anomalous biliopancreatic junction ), and one pt with a subpapilar duodenal duplication cyst confirmed by ERCP and treated endoscopically. Two pts had a normal EUS and ERCP. EUS showed in 3 pts with submucosal tumors diagnosed by gastroscopy and normal biopsies: 1 lipoma, 1 ectopic pancreas and 1 bronchogenic cyst. 3 patients with extrahepatic cholestasis (two with normal conventional US) had gallblladder minilithiasis with normal CBD. 2 patients with acute pancreatitis showed at EUS gallbladder minilithiasis with normal CBD. All five patients avoided diagnostic ERCP with a normal resolution. One patient with Zollinger-Ellison syndrome showed a normal pancreatic body and tail, without a head evaluation due to surgical history and the gastrinoma remains unlocated. CONCLUSIONS: EUS is a safe and effective complementary method for gastrointestinal pediatric pathologies. EUS can identify etiologies after rutine explorations and avoid diagnostic ERCP, and ES should be use has a therapeutic procedure.