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

ABSTRACT Background: Endoscopic ultrasound (EUS) with or without fine needleaspiration (FNA) has a well-established role in the evaluation of variousgastrointestinal (GI) tract disorders in adults. The clinical impact of EUS onthe management of the pediatric population remains less clear. This studyevaluatesthefeasibility, safety,andapplications of EUS FNAinpediatricGI tract disorders.PatientsandMethods:UsingaprospectivelymaintainedEUSdatabase,allpatients 18 years of age or younger referred for EUS at our institution wereidentified.Retrospectivechartreviewwasconductedtodocumentprocedureindications, type of anesthesia used, EUS findings, final FNA cytologyresults,andclinicalimpactofEUS FNAonthesubsequentmanagementofpediatric patients.Results: Fifty-eight EUS procedures were performed in 56 patients(35 girls). Median age was 16 years (range 4–18 years). The mainindications for EUS were acute or recurrent pancreatitis, abdominal painofsuspectedpancreatobiliaryorigin,suspectedbiliaryobstruction,upperGImucosal/submucosal lesions, and evaluation of pancreatic abnormalitiesseen on prior imaging. Sedation used included nurse-administered propofolsedation in 38 (73%), general anesthesia in 9 (17%), and fentanyl withmeperidine in 3 (6%). Five therapeutic procedures performed includedceliac plexus blocks in 4 and 1 EUS-guided pancreatogram. In 44 (86%)patients, EUS provided a new diagnosis. The procedure was successfullycompleted in all patients with no reported complications.Conclusions: EUS FNA is feasible and safe and makes a significantimpact on most pediatric patients. Nurse-administered propofol sedationappears to be safe and well tolerated in this group.Key Words: children, endoscopic ultrasound, fine needle aspiration,gastrointestinal tract disorders, nurse-administered propofol sedation