Diagnostic and therapeutic role of endoscopic ultrasound in children’s pancreaticobiliary disorders

Background and Objectives: The diagnostic role of endoscopic ultrasound (EUS) in children has been demonstrated only recently. Data on the technique’s therapeutic indications remain scarce. We evaluated diagnostic and interventional EUS indications, safety, and impact in children with pancreaticobiliary disorders. Patients and Methods: We retrospectively reviewed our single pediatric center experience covering a 14-year period. Results: Between January 2000 and 2014, 52 EUS procedures were performed on 48 children (mean age 12 years) with pancreaticobiliary disorders for suspected biliary obstruction ( n = 20/52), acute/chronic pancreatitis ( n = 20), pancreatic mass ( n = 3), pancreatic blunt trauma ( n = 7), and ampullary adenoma ( n = 2). Positive impact of EUS was observed in 51/52 procedures (98%), precluding using endoscopic retrograde cholangiopancreatography (ERCP) ( n = 9), focusing on endotherapy ( n = 21), or reorienting therapy toward surgery ( n = 7). EUS-guided fine needle aspiration was carried out on 12 patients. Thirteen therapeutic EUS procedures were conducted, nine of which were combined EUS-ERCP procedures (three EUS-guided pseudocyst drainage, one EUS-guided transgastric biliary drainage of a metastatic rhabdomyosarcoma). Conclusions: We report on a large pediatric EUS series for diagnostic and therapeutic pancreaticobiliary disorders, showing a significant impact of diagnostic EUS and affording insights into novel EUS and combined EUS-ERCP therapeutic applications. We suggest considering EUS as a diagnostic and therapeutic tool in the management of pediatric biliopancreatic diseases.