Role of Endoscopic Ultrasound for Evaluating Gastrointestinal Tract Disorders in Pediatrics: A Tertiary Care Center Experience

Al-Rashdan, Abdulla; Leblanc, Julia K.; Sherman, Stuart; McHenry, Lee; DeWitt, John M.; Al‐Haddad, Mohammad

doi:10.1097/mpg.0b013e3181dac094

Cited by 40 publications

(53 citation statements)

References 23 publications

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“…However, data on its safety and ability to impact clinical care among pediatric patients is limited to a few case series [Table 3]. [12345] Most of these case series are based on a small cohort of patients, but they all have uniformly suggested that EUS is safe and makes a meaningful impact on the care of pediatric patients. [125] Here, we present our experience with pediatric EUS, and our study represents one of the largest case series addressing the feasibility and the safety of EUS in pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…[13456] Some noticeable differences were that 14% (8/58) of our cases were for suspected insulinoma; six patients had hereditary cancer syndromes and were undergoing EUS for surveillance or for the evaluation of gastro-duodenal polyps. Although these differences are reflective of practice patterns and differences in the tertiary referral patterns, our study provides safety data on additional indications in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…in a recent series of 56 patients demonstrated that 73% of cases (all more than 10 years of age) could be safely sedated with nurse-administered propofol. [1] While GA seems to be a modality suitable for younger children undergoing complex EUS procedures and for children undergoing lengthy procedures, using MAC selectively in otherwise healthy older children appears to be a safe alternative.…”

Section: Discussionmentioning

confidence: 99%

“…While this modality has been used among pediatric populations, the literature on safety, efficacy, and ability to make a clinical impact in this population is limited to only a few studies. [12345] This is partly explained by the lower incidence of luminal and pancreaticobiliary malignancies among the pediatric population and also by a paucity of experienced endosonographers interacting with a pediatric patient population. This study was designed to analyze and report pediatric EUS experience at a single tertiary care system.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population

et al. 2017

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Background and Objectives:The safety and utility of endoscopic ultrasound (EUS) for the evaluation and management of gastrointestinal (GI) tract disorders among adults has been established. The literature on safety and efficacy in a pediatric referral population (under 21 years of age) is limited. We hypothesized that EUS is safe and useful in the pediatric population. We reviewed the pediatric EUS experience at a single tertiary-care system. We describe the indications, findings, safety, technical success rate, and impact on clinical outcomes.Patients and Methods:All patients 21 years of age or younger referred for EUS between 5, 2007 and 11, 2012 were identified from our electronic medical record databases. Retrospective chart review was then conducted to document demographics, procedure indications, procedure type (diagnostic or therapeutic), type of anesthesia used, EUS findings, and the clinical impact of EUS on the subsequent management of the patients.Results:Seventy EUS procedures were attempted in 58 patients during the study. Of these, two EUS procedures were aborted due to inadequate moderate sedation and 68 were successfully completed. The median age at initial endoscopy was 18 years (range 6–21 years), 50% were male and 65% were Caucasian. Four patients underwent EUS-guided pseudocyst drainage. Among the remaining 54 patients, the indications for EUS were the evaluation of GI mucosal/submucosal lesions (n = 14), acute or recurrent pancreatitis (n = 10), localization of suspected insulinoma (n = 8), evaluation of pancreatic abnormalities seen on prior imaging (n = 6), surveillance of tumors or evaluation of luminal lesions in hereditary syndromes (n = 6), abdominal pain of suspected pancreatobiliary origin (n = 5), and other rare indications (n = 5). Fine-needle aspiration was performed in 13 (9 diagnostic, 4 therapeutic) and trans-gastric fine-needle contrast injection of the pancreatic duct was performed in one patient without any complications. Sedation (data available for 66 procedures) included general endotracheal anesthesia in 38 (57%), monitored anesthesia care (MAC) in 19 (29%), and moderate sedation in 9 (14%). There were 4 minor intra-procedural anesthesia-related complications (laryngospasm in 2 and hypoxemia from airway obstruction and secretions in 2) in MAC and general endotracheal anesthesia (GA) cases, and 1 postprocedural complication (fever after pseudocyst drainage). EUS can achieve the diagnostic or therapeutic goal and ruled out suspected pathology in 88% of cases precluding need for additional testing.Conclusions:(1) EUS in the pediatric population is technically successful and efficacious. (2) Therapeutic and diagnostic EUS impacted clinical care decisions. (3) There is a low risk of immediate significant complications. (4) The overall efficacy and safety support the performance of EUS in a pediatric population by experienced endoscopists.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population

et al. 2017

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“…[123] A recent novel application in adults is EUS-guided liver biopsy (EUS-LB) which has proven to be technically safe, and provides adequate tissue yields for evaluation of liver disease;[4567] but the use of EUS-LB has never been reported in the pediatric population. We report the first case series of EUS-LB performed in the pediatric population.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic ultrasound-guided liver biopsy in pediatric patients

et al. 2014

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Endoscopic ultrasound (EUS) is routinely used for diagnostic and therapeutic purposes in adults, and there is emerging literature on its feasibility and safety in children. A recent novel application is EUS-guided liver biopsy (EUS-LB), which has shown to be technically simple, safe, and provides adequate diagnostic yield in adults for evaluation of liver disease; but the use of EUS-LB has never been evaluated in the pediatric population. We report the first case series of EUS-LB in the pediatric population, performed on 3 children, 1 girl and 2 boys-ages 9, 14 and 17 respectively, using a 19-gauge EUS-fine needle aspiration needle. All three cases were performed for the evaluation of unexplained elevated liver enzymes, with above-average diagnostic yield and without any immediate or delayed complications in all children. The use of EUS-LB was pivotal in the management of all the cases. Our case series illustrates the diagnostic utility and safety of EUS-LB in pediatric patients.

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Endoscopic ultrasonography

Faraci¹,

Dall’Oglio²,

Angelis³

et al. 2021

Practical Pediatric Gastrointestinal Endoscopy

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Role of Endoscopic Ultrasound for Evaluating Gastrointestinal Tract Disorders in Pediatrics: A Tertiary Care Center Experience

Abstract: EUS ± FNA is feasible and safe and makes a significant impact on most pediatric patients. Nurse-administered propofol sedation appears to be safe and well tolerated in this group.

Cited by 40 publications

References 23 publications

Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population

Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population

Endoscopic ultrasound-guided liver biopsy in pediatric patients

Endoscopic ultrasonography

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