Endoscopic Ultrasound in Pediatric Gastroenterology

Abstract

Purpose: The value of endoscopic ultrasound (EUS) in the evaluation and diagnosis of gastrointestinal disorders in adults is well recognized. Although the number of publications and reports of EUS applications in pediatric patients has been increasing in recent years, the medical literature is still limited. We describe our initial experience with EUS as a diagnostic tool in pediatric patients. Methods: We reviewed all EUS procedures performed at our institution between Sept 2002 and May 2006. EUS was performed using conventional adult echoendoscopes (Pentax EG-3630 UR and EG-3630 U models) by a single endosonographer (AAG). Patients younger than 18 years of age were included in the study. We obtained demographic data, indications and EUS findings as well as follow-up information and outcomes of these patients. Results: A total of seven pediatric patients underwent EUS in the period reviewed. The mean age was 11.7 years (range 7–17), 3 male and 4 female. All patients were >18 kg in weight. EUS was performed with a pediatric anesthesiologist providing IV sedation in all cases. All patients had radial endosonography, two undergoing linear array EUS for FNA of abnormal lesions found during the study. The indications for the procedure included recurrent pancreatitis of unknown origin (4 patients), submucosal lesions of the stomach (2 patients), and an apparent rectal adenocarcinoma for staging (1 patient). All procedures were performed safely without immediate or long-term complications. EUS findings included gallstone disease (2 patients), chronic pancreatitis (1 patient), non-obstructive jaundice (1 patient), and UC in the patient with apparent malignancy of the rectum. The two submucosal gastric masses undergoing EUS-FNA were reported as benign lesions. EUS provided valuable information and had a direct impact in the management decisions made for all patients. Conclusions: In experienced hands, EUS and EUS-FNA can be safely performed in pediatric patients who weigh more than 18 kg using regular adult echoendoscopes, always under assistance of a pediatric anesthesiologist. Our most common indications for EUS in pediatric patients included the evaluation of recurrent pancreatitis of unknown etiology and the presence of submucosal lesions of the GI tract found during routine endoscopy. EUS and EUS-FNA, when indicated, can provide useful information in the decision-making process for the evaluation and treatment of selected pediatric patients.