Endoscopic Ultrasound in

Pediatric GI DiseaseQuin Y. Liu, MD

Interventional Gastroenterology

Cedars-Sinai Medical Center

Los Angeles, CA

•No financial disclosures

•No conflicts of interest

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•Discuss the technical challenges in pediatric EUS

•Discuss the clinical indication for Endoscopic Ultrasound (EUS) in children

Objectives

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•EUS endoscopes outer diameter range between 11.4 – 13.9mm.

•Increase risk:

¡Cervical esophageal perforation

¡Duodenal perforation

•EUS reported to be done in children as young as 6 months of age*

•Availability of EUS is limited by the few pediatric gastroenterologist appropriately trained in EUS, and by the relatively small number of adult gastroenterologist who are able to perform EUS in children

Clinical Challenges

4*Al-Rashdan A,etal.J.Pediatr GastroNutr 2010

Big scope, small patient

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EUS indications

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•Do not see as much GI cancers in pediatrics

•Bile duct stones

•Pancreas diseases

¡Chronic pancreatitis

¡Pancreatic fluid collections

•Congenital malformations

¡Congenital esophageal stenosis

EUS Indications

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•3 types

¡Fibromuscular

¡Tracheobronchial remnant (TBR)

¡Membranous web

•TBR refractory to endoscopic dilation and usually requires surgical resection

¡Difficult to visualize on CT or MRI

¡EUS can usually differentiate TBR from fibromuscular and membranous

Congenital esophageal stenosis

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•Size

¡Consider the size of the pseudocyst relative to the size of the patient

•Etiology

¡Rarely alcoholic pancreatitis

¡Possibly gallstone pancreatitis

¡Medication, idiopathic and hereditary pancreatitis

Considerations in pediatric pseudocyst management

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Pseudocyst drainage

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Luminal apposing metal stent (LAMS)

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LAMS vs plastic stents

12NietoJ,etal.GIEMay2017AB45-46

•EUS can be performed in pediatric population safely

•Consider patient size in relation to endoscope size

•May need to be more conservative with metal stent placement for pseudocyst drainage

Summary

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