EUS in the Diagnosis and Management of Esophageal Pathology in Children

EUS in the Diagnosis and Management of Esophageal Pathology in Children Antonio Quiros, Shiro Urayama There is minimal published data for the use of EUS in the diagnosis and management of UGI pathology in children.We are interested in the utility of EUS during the initial evaluation in children for suspected UGI pathology. Case 1: 17 yo HM with Down’s, ALL and currently under treatment for CNS relapse. Evaluated for a 3 mo hx of recurrent vomiting, abdominal pain and significant weight loss requiring parenteral nutrition. UGI and CT scan showed lower esophageal wall thickening at GE junction with luminal narrowing and proximal dilatation. A 4mmdiameter pediatric endoscopewas passed through stricture area revealing a grossly normal gastric fundus and body and confirming the stricture length at 1 cm. Case 2: 2 yo HM with an 18 mo history of poor weight gain, recurrent emesis, feeding dysfunction and aversion to textured foods and solids. PE, developmental history and response supplemental enteral nutrition formula are normal. UGI and CT scan revealed a 2cm x 2cm cystic mass compressing on esophageal lumenwith unclear relation to esophageal wall just aboveGE junction. EGD study showed a luminal protrusion approximately 2 cm above the Z-line which had a bluish hue andwas non-pulsatile. On further examination it was noted that a 0.5 cm hiatal hernia existed with mild reflux esophagitis. Case 3: 4 yo CCM with Down’s, poor weight gain due to feeding problems and emesis since infancy. Chronic emesis of ‘‘undigested’’ food noted after solids introduced, esophageal web was suspected during swallow study and UGI revealed a possible indentation in mid-thoracic esophagus suggestive of a mass or external compression. EGD revealed no esophageal web and an indentation 7 cm above the LES which occluded about 50% of the esophageal lumen. An Olympus 20 Mhz ultrasound miniprobewas used to examine the areas of interest. In the first case, themuscularis propria layer around the GE junction was identified measuring 2mm in thickness, ruling out achalasia or any intramural tumor. Prominent mucosal thickening only was noted on the exam. A balloon dilatation was perfomed and this patient went home on liquid diet after 3 days. In our second case, EUS showed a cystic lesion which sharedmuscular layer with the normal esophagus but hadwhat appeared as a uniform mucosal lining with no septations. In our 3rd case, a clear vascular structure was identified wrapping around the anterolateral wall of the esophagus. These cases illustrate the utility of EUS and suggest its possible role within the management algorithm of UGI pathology in pediatric patients.