Diagnostic utility of EUS-guided tissue acquisition in children: A tertiary care center experience

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.

Safety and efficacy of endoscopic ultrasound as a diagnostic and therapeutic tool in pediatric patients: a multicenter study

“…The feasibility, safety, and diagnostic utility of EUS-guided tissue acquisition in pediatrics with different indications were reported by a large Indian study including 76 cases. 17 The main indications for EUS in this report were solid pancreatic tumors (43.3%) and lymphadenopathy (44.7%). The authors confirmed the successfulness of all procedures without major complications.…”

Role of endoscopic ultrasound-guided fine needle aspiration biopsies in diagnosing pancreatic neoplasms in the paediatric population: experience from a tertiary center and review of the literature

“…The endoscopists were very experienced in the management of adult patients, enabling the procedure to be safe and efficient also in the pediatric patients, which corresponds well with other studies. 1 , 3 , 8 , 9 , 10 , 11 , 16 , 17 , 18 While EUS was shown previously as a safe diagnostic method in the pediatric population, covering the age range of our patients (age 8 and 9 years, respectively), there is limited experience with EUS especially in smaller children (< 15 kg) due to the fear of an esophageal rupture associated with the large diameter (adult) EUS scope. Therefore, for smaller children (< 15 kg) endobronchial ultrasound has been used instead and a few studies have shown that EUS can be performed safely and with a high diagnostic accuracy even in these children.…”

“…According to the reviewed literature ( Table 2 ), the adoption of EUS for children with pancreatobilliary diseases was delayed due to different reasons, among them the low incidence of tumorous lesions and even rarer malignancies. 8 Other important reasons were also the size limitation of EUS equipment relative to pediatric anatomy, the low number of skilled pediatric endoscopists with EUS expertise, the need for sedation or general anesthesia, and a limited awareness among pediatric practitioners of EUS diagnostic and therapeutic possibilities. 3 , 8 In our patients, the procedure and equipment used was similar to the adult population, apart from the use of general anaesthesia.…”

“… 8 Other important reasons were also the size limitation of EUS equipment relative to pediatric anatomy, the low number of skilled pediatric endoscopists with EUS expertise, the need for sedation or general anesthesia, and a limited awareness among pediatric practitioners of EUS diagnostic and therapeutic possibilities. 3 , 8 In our patients, the procedure and equipment used was similar to the adult population, apart from the use of general anaesthesia. The endoscopists were very experienced in the management of adult patients, enabling the procedure to be safe and efficient also in the pediatric patients, which corresponds well with other studies.…”

Endoscopic ultrasound-guided tissue acquisition: Needle types, technical issues, and sample handling

“…66 There is no absolute contraindication to EUS-guided tissue acquisition, but caution is required in cases of cardiopulmonary instability, bleeding tendency with coagulopathy or thrombocytopenia, and recent use of anticoagulants or antiplatelets. 67…”