Impact of EUS in the Evaluation of Pancreatico-Biliary Disorders in Children

Abstract

Background: The evaluation of pancreatico-biliary (PB) disorders in children is a major diagnostic challenge. While the role of EUS in the evaluation of PB disorders in adults is well established, its utility in children remains unproven. Aim: To assess the feasibility, safety, and impact of EUS in the evaluation of PB disorders in children. Methods: Prospective study of all children (< 18 yrs) referred for ERCP for evaluation of suspected PB disorders who underwent EUS prior to scheduled ERCP. Diagnostic EUS was performed using Olympus GF-UM130 radial scanner and fine needle aspiration (EUS-FNA) using Olympus UC-30P. General anesthesia was used for sedation in all patients. Complications were assessed by 30-day follow-up. EUS was considered to have significant impact if a new diagnosis was established or if the findings altered subsequent management. Results: Sixteen children (10 boys; mean age 13 yrs; range 5-17) underwent 17 procedures over a 3-yr period. Main indications were: acute or recurrent pancreatitis in 7, suspected biliary obstruction (5), and abdominal pain suggestive of PB origin (4). EUS diagnosed chronic pancreatitis in 4, idiopathic fibrosing pancreatitis (2), carcinoid tumor (1), pancreatic pseudocyst (1), pancreas divisum (1), choledocholithiasis (1), duodenal duplication cyst (1), and was normal in 5. Diagnosis of idiopathic fibrosing pancreatitis and carcinoid tumor was established by EUS-FNA. The procedure was successful in all patients and no complications were encountered. EUS had an impact on patient management in 94% of cases: established new diagnosis in 11, precluded need for more invasive testing (ERCP) in 10, and provided additional information that facilitated focused endotherapy in 5. Summary: 1) EUS is feasible, safe, and impacts management in > 4/5th of children with suspected PB disorders. 2) It helps avoid more invasive testing in > 60% of patients. 3) Despite its availability, children comprised <1% (16/2500) of all patients who underwent EUS at our center. Conclusions: EUS and EUS-FNA are feasible, safe, and have significant impact that alters subsequent management in majority of children with pancreatico-biliary disorders. Further studies and dissemination of information is required to facilitate its increased application in children. Background: The evaluation of pancreatico-biliary (PB) disorders in children is a major diagnostic challenge. While the role of EUS in the evaluation of PB disorders in adults is well established, its utility in children remains unproven. Aim: To assess the feasibility, safety, and impact of EUS in the evaluation of PB disorders in children. Methods: Prospective study of all children (< 18 yrs) referred for ERCP for evaluation of suspected PB disorders who underwent EUS prior to scheduled ERCP. Diagnostic EUS was performed using Olympus GF-UM130 radial scanner and fine needle aspiration (EUS-FNA) using Olympus UC-30P. General anesthesia was used for sedation in all patients. Complications were assessed by 30-day follow-up. EUS was considered to have significant impact if a new diagnosis was established or if the findings altered subsequent management. Results: Sixteen children (10 boys; mean age 13 yrs; range 5-17) underwent 17 procedures over a 3-yr period. Main indications were: acute or recurrent pancreatitis in 7, suspected biliary obstruction (5), and abdominal pain suggestive of PB origin (4). EUS diagnosed chronic pancreatitis in 4, idiopathic fibrosing pancreatitis (2), carcinoid tumor (1), pancreatic pseudocyst (1), pancreas divisum (1), choledocholithiasis (1), duodenal duplication cyst (1), and was normal in 5. Diagnosis of idiopathic fibrosing pancreatitis and carcinoid tumor was established by EUS-FNA. The procedure was successful in all patients and no complications were encountered. EUS had an impact on patient management in 94% of cases: established new diagnosis in 11, precluded need for more invasive testing (ERCP) in 10, and provided additional information that facilitated focused endotherapy in 5. Summary: 1) EUS is feasible, safe, and impacts management in > 4/5th of children with suspected PB disorders. 2) It helps avoid more invasive testing in > 60% of patients. 3) Despite its availability, children comprised <1% (16/2500) of all patients who underwent EUS at our center. Conclusions: EUS and EUS-FNA are feasible, safe, and have significant impact that alters subsequent management in majority of children with pancreatico-biliary disorders. Further studies and dissemination of information is required to facilitate its increased application in children.