Introduction
Endoscopic ultrasound (EUS) emerged as a revolutionary intervention in gastroenterology, it has been extensively utilized among adult patients, however EUS utility in pediatric patients has remained limited due to EUS endoscope design which includes rigidity, diameter, traumatic distal tip, further more complicated by need of Monitored Anesthesia Care (MAC) or General Anesthesia (GA) for intervention which require specialized pediatric anesthesia team[i]. Fewer studies have been conducted so far regarding EUS utility, effectiveness and safety among children, most of the studies have smaller data. Recently, the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and the European Society of Gastrointestinal Endoscopy (ESGE) have published joint guidelines for EUS in children which highlights the various indications for EUS in children[ii].In Pakistan, only few endoscopy centers are performing pediatric EUS.
Aims & Methods
This article aims to describe the safety along with technical and clinical success of EUS for both diagnostic and therapeutic purposes among children at a tertiary referral endoscopy center in Pakistan.
Retrospective charts review of patients ≤ 18 years of age who underwent EUS for disgnostic or therapeutic purpose over 10 years, from 2015 to 2024, at Sindh Institute of Advanced Endoscopy and Gastroenterology. This institute was initially working under Civil Hospital Karachi as Endoscopy Suite of S4 Unit. Since May 2023, it has been working as a separate endoscopy unit. This endoscopy center is a referral unit located in the largest city of Pakistan.
Results
A total of 130 patients ≤ 18 years age had EUS, the youngest was 5 years old and 54.3% were male gender. Primary indication for EUS examination included: 35 chronic pancreatitis, 39 pancreatic pseudocyst, 12 pancreatic mass, 3 biliary obstruction with suspected choledochal cyst, 2 liver biopsy, 21 gastrointestinal tract lesions, 6 lymph nodes and 12 other causes. 96 EUS were performed for diagnostic purpose, in which 20 patients underwent fine needle biopsy and 6 underwent fine needle aspiration. Among therapeutic EUS, patients underwent 21 EUS guided pseudocyst drainage, one patient had EUS guided walled off necrosis drainage, 4 patients underwent celiac plexus block referred for pain management of chronic pancreatitis,one patient underwent EUS guided pancreatic duct cannulation and stent placement and one patient had EUS guided randezvous procedure. All therapeutic procedures were performed under general anesthesia whereas diagnostic EUS were performed under monitored anesthesia care. No immediate or early complications were seen.
Conclusion
In this modern era of advanced diagnostic tools and minimally invasive interventions, EUS related procedures are safe and effective in pediatric group of patients too. However, this procedure should be standardized and performed at centers with trained endoscopists and an experienced pediatric anesthesia team.
References
[i] Thomson, M., Tringali, A., Dumonceau, J.-M., Tavares, M., Tabbers, M.M., Furlano, R., Spaander, M., Hassan, C., Tzvinikos, C., Ijsselstijn, H., Viala, J., Dall'Oglio, L., Benninga, M., Orel, R., Vandenplas, Y., Keil, R., Romano, C., Brownstone, E., Hlava, Š., Gerner, P., Dolak, W., Landi, R., Huber, W.D., Everett, S., Vecsei, A., Aabakken, L., Amil-Dias, J. and Zambelli, A. (2017), Paediatric Gastrointestinal Endoscopy. Journal of Pediatric Gastroenterology and Nutrition, 64: 133-153. https://doi.org/10.1097/MPG.0000000000001408.
[ii] Thomson, M., Tringali, A., Dumonceau, J.-M., Tavares, M., Tabbers, M.M., Furlano, R., Spaander, M., Hassan, C., Tzvinikos, C., Ijsselstijn, H., Viala, J., Dall'Oglio, L., Benninga, M., Orel, R., Vandenplas, Y., Keil, R., Romano, C., Brownstone, E., Hlava, Š., Gerner, P., Dolak, W., Landi, R., Huber, W.D., Everett, S., Vecsei, A., Aabakken, L., Amil-Dias, J. and Zambelli, A. (2017), Paediatric Gastrointestinal Endoscopy. Journal of Pediatric Gastroenterology and Nutrition, 64: 133-153. https://doi.org/10.1097/MPG.0000000000001408