Skip to main content
Log in

The emerging role of endoscopic ultrasound for pancreaticobiliary diseases in the pediatric population

  • Review Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

Endoscopic ultrasound (EUS) is a useful diagnostic and therapeutic tool in the pediatric population. Given the high accuracy and sensitivity of EUS, it is particularly effective in evaluating pancreaticobiliary disease. Published literature in the use of pediatric EUS is limited. Therefore we aimed to review the current literature for EUS indications, safety, and effectiveness for the pediatric population.

Data sources

English language articles on the use of pediatric endoscopic ultrasound in evaluating pancreaticobiliary diseases were retrieved from PubMed/ MEDLINE.

Results

We analyzed various retrospective studies and case series publications. Data were extrapolated for pediatric patients with pancreaticobiliary diseases.

Conclusions

EUS offers superior imaging. It is comparible to magnetic resonance imaging and/or pancreatic-protocol computed tomography. In the current literature, there are a variety of pancreaticobiliary conditions where EUS was utilized to make a diagnosis. These include recurrent pancreatitis, congenital anomalies, microlithiasis, pancreatic pseudocysts, and pancreatic mass lesions. EUS was shown to be a safe and cost-effective modality with both diagnostic and therapeutic capabilities in the pediatric population. EUS is now increasingly being recognized as a standard of care when evaluating pancreaticobiliary conditions in children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Varadarajulu S, Wilcox CM, Hawes RH, Cotton PB. Technical outcomes and complications of ERCP in children. Gastrointest Endosc 2004;60:367–371.

    Article  PubMed  Google Scholar 

  2. Endoscopic ultrasound-a backgrounder, 2010. http://www.olympusamerica.com/presspass/press_pass_cut/documents/ EUSBackgrounder.pdf (accessed April 20, 2015).

  3. Sivak MV Jr. EUS: past, present, and the future of endoscopy. Gastrointest Endosc 2002;55:446–448.

    Article  PubMed  Google Scholar 

  4. Benaroch LM, Rudolph CD. Introduction to pediatric esophagogastroduodenoscopy and enteroscopy. Gastrointest Endosc Clin N Am 1994;4:121–142.

    CAS  PubMed  Google Scholar 

  5. Asge Standards of Practice Committee, Lee KK, Anderson MA, Baron TH, Banerjee S, Cash BD, et al. Modifications in endoscopic practice for pediatric patients. Gastrointest Endosc 2008;67:1–9.

    Article  Google Scholar 

  6. Cohen S, Kalinin M, Yaron A, Givony S, Reif S, Santo E. Endoscopic ultrasonography in pediatric patients with gastrointestinal disorders. J Pediatr Gastroenterol Nutr 2008;46:551–554.

    Article  PubMed  Google Scholar 

  7. Iqbal S, Friedel D, Gupta M, Ogden L, Stavropoulos SN. Endoscopic-ultrasound-guided fine-needle aspiration and the role of the cytopathologist in solid pancreatic lesion diagnosis. Patholog Res Int 2012;2012:317167.

    PubMed  PubMed Central  Google Scholar 

  8. Yusuf TE, Bhutani MS. Role of endoscopic ultrasonography in diseases of the extrahepatic biliary system. J Gastroenterol Hepatol 2004;19:243–250.

    Article  PubMed  Google Scholar 

  9. Akahoshi K, Chijiwa Y, Hamada S, Sasaki I, Nawata H, Kabemura T, et al. Pretreatment staging of endoscopically early gastric cancer with a 15 MHz ultrasound catheter probe. Gastrointest Endosc 1998;48:470–476.

    Article  CAS  PubMed  Google Scholar 

  10. Tio TL, Tytgat GN. Endoscopic ultrasonography of normal and pathologic upper gastrointestinal wall structure. Comparison of studies in vivo and in vitro with histology. Scand J Gastroenterol Suppl 1986;123:27–33.

    Article  CAS  PubMed  Google Scholar 

  11. Singla V, Garg PK. Role of diagnostic and therapeutic endoscopic ultrasonography in benign pancreatic diseases. Endosc Ultrasound 2013;2:134–141.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Srinath AI, Lowe ME. Pediatric pancreatitis. Pediatr Rev 2013;34:79–90.

    Article  PubMed  Google Scholar 

  13. Lowe ME. Pancreatitis in childhood. Curr Gastroenterol Rep 2004;6:240–246.

    Article  PubMed  Google Scholar 

  14. Suzuki M, Sai JK, Shimizu T. Acute pancreatitis in children and adolescents. World J Gastrointest Pathophysiol 2014;5:416–426.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Attila T, Adler DG, Hilden K, Faigel DO. EUS in pediatric patients. Gastrointest Endosc 2009;70:892–898.

    Article  PubMed  Google Scholar 

  16. Al-Rashdan A, Le Blanc J, Sherman S, McHenry L, De Witt J, Al-Haddad M. Role of endoscopic ultrasound for evaluating gastrointestinal tract disorders in pediatrics: a tertiary care center experience. J Pediatr Gastroenterol Nutr 2010;51:718–722.

    Article  PubMed  Google Scholar 

  17. Varadarajulu S, Wilcox CM, Eloubeidi MA. Impact of EUS in the evaluation of isorders in children. Gastrointest Endosc 2005;62:239–244.

    Article  PubMed  Google Scholar 

  18. Bjerring OS, Durup J, Qvist N, Mortensen MB. Impact of upper gastrointestinal endoscopic ultrasound in children. J Pediatr Gastroenterol Nutr 2008;47:110–113.

    Article  CAS  PubMed  Google Scholar 

  19. Fujii LL, Chari ST, El-Youssef M, Takahashi N, Topazian MD, Zhang L, et al. Pediatric pancreatic EUS-guided trucut biopsy for evaluation of autoimmune pancreatitis. Gastrointest Endosc 2013;77:824–828.

    Article  PubMed  Google Scholar 

  20. Scheers I, Ergun M, Aouattah T, Piessevaux H, Borbath I, Stephenne X, et al. Diagnostic and therapeutic role of endoscopic ultrasound in pediatric pancreaticobiliary disorders. J Pediatr Gastroenterol Nutr 2015;61:238–247.

    Article  PubMed  Google Scholar 

  21. Catalano MF, Lahoti S, Geenen JE, Hogan WJ. Prospective evaluation of endoscopic ultrasonography, endoscopic retrograde pancreatography, and secretin test in the diagnosis of chronic pancreatitis. Gastrointest Endosc 1998;48:11–17.

    Article  CAS  PubMed  Google Scholar 

  22. Brand B, Pfaff T, Binmoeller KF, Sriram PV, Fritscher-Ravens A, Knofel WT, et al. Endoscopic ultrasound for differential diagnosis of focal pancreatic lesions, confirmed by surgery. Scand J Gastroenterol 2000;35:1221–1228.

    Article  CAS  PubMed  Google Scholar 

  23. Chang KJ, Albers CG, Erickson RA, Butler JA, Wuerker RB, Lin F. Endoscopic ultrasound-guided fine needle aspiration of pancreatic carcinoma. Am J Gastroenterol 1994;89:263–266.

    CAS  PubMed  Google Scholar 

  24. Gerke H, Baillie J. Biliary microlithiasis: a neglected cause of recurrent pancreatitis and biliary colic? J Gastroenterol Hepatol 2005;20:499–501.

    Article  PubMed  Google Scholar 

  25. Surlin V, Saftoiu A, Dumitrescu D. Imaging tests for accurate diagnosis of acute biliary pancreatitis. World J Gastroenterol 2014;20:16544–16549.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Neff LP, Mishra G, Fortunato JE, Laudadio J, Petty JK. Microlithiasis, endoscopic ultrasound, and children: not just little gallstones in little adults. J Pediatr Surg 2011;46:462–466.

    Article  PubMed  Google Scholar 

  27. Li H, Qian Z, Liu Z, Liu X, Han X, Kang H. Risk factors and outcome of acute renal failure in patients with severe acute pancreatitis. J Crit Care 2010;25:225–229.

    Article  CAS  PubMed  Google Scholar 

  28. Shi LB, Peng SY, Meng XK, Peng CH, Liu YB, Chen XP, et al. Diagnosis and treatment of congenital choledochal cyst: 20 years’ experience in China. World J Gastroenterol 2001;7:732–734.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Meza-Junco J, Montano-Loza AJ, Ma M, Wong W, Sawyer MB, Bain VG. Cholangiocarcinoma: has there been any progress? Can J Gastroenterol 2010;24:52–57.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wu GS, Zou SQ, Luo XW, Wu JH, Liu ZR. Proliferative activity of bile from congenital choledochal cyst patients. World J Gastroenterol 2003;9:184–187.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Songur Y, Temucin G, Sahin B. Endoscopic ultrasonography in the evaluation of dilated common bile duct. J Clin Gastroenterol 2001;33:302–305.

    Article  CAS  PubMed  Google Scholar 

  32. Huang SP, Wang HP, Chen JH, Wu MS, Shun CT, Lin JT. Clinical application of EUS and peroral cholangioscopy in a choledochocele with choledocholithiasis. Gastrointest Endosc 1999;50:568–571.

    Article  CAS  PubMed  Google Scholar 

  33. Kimura K, Ohto M, Saisho H, Unozawa T, Tsuchiya Y, Morita M, et al. Association of gallbladder carcinoma and anomalous pancreaticobiliary ductal union. Gastroenterology 1985;89:1258–1265.

    Article  CAS  PubMed  Google Scholar 

  34. Komi N, Tamura T, Miyoshi Y, Kunitomo K, Udaka H, Takehara H. Nationwide survey of cases of choledochal cyst. Analysis of coexistent anomalies, complications and surgical treatment in 645 cases. Surg Gastroenterol 1984;3:69–73.

    CAS  PubMed  Google Scholar 

  35. Kamisawa T, Takuma K, Itokawa F, Itoi T. Endoscopic diagnosis of pancreaticobiliary maljunction. World J Gastrointest Endosc 2011;3:1–5.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Yang MC, Duh YC, Lai HS, Chen WJ, Chen CC, Hung WT. Alimentary tract duplications. J Formos Med Assoc 1996;95:406–409.

    CAS  PubMed  Google Scholar 

  37. Romeo E, Torroni F, Foschia F, De Angelis P, Caldaro T, Santi MR, et al. Surgery or endoscopy to treat duodenal duplications in children. J Pediatr Surg 2011;46:874–878.

    Article  PubMed  Google Scholar 

  38. Stimec B, Bulajic M, Korneti V, Milosavljevic T, Krstic R, Ugljesic M. Ductal morphometry of ventral pancreas in pancreas divisum. Comparison between clinical and anatomical results. Ital J Gastroenterol 1996;28:76–80.

    CAS  PubMed  Google Scholar 

  39. Shanbhogue AK, Fasih N, Surabhi VR, Doherty GP, Shanbhogue DK, Sethi SK. A clinical and radiologic review of uncommon types and causes of pancreatitis. Radiographics 2009;29:1003–1026.

    Article  PubMed  Google Scholar 

  40. Di Magno MJ, Wamsteker EJ. Pancreas divisum. Curr Gastroenterol Rep 2011;13:150–156.

    Article  Google Scholar 

  41. Rana SS, Bhasin DK, Sharma V, Rao C, Singh K. Role of endoscopic ultrasound in the diagnosis of pancreas divisum. Endosc Ultrasound 2013;2:7–10.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Pitchumoni CS, Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed? Gastroenterol Clin North Am 1999;28:615–639.

    Article  CAS  PubMed  Google Scholar 

  43. Yachha SK, Chetri K, Saraswat VA, Baijal SS, Sikora SS, Lal R, et al. Management of childhood pancreatic disorders: a multidisciplinary approach. J Pediatr Gastroenterol Nutr 2003;36:206–212.

    Article  PubMed  Google Scholar 

  44. Bass J, Di Lorenzo M, Desjardins JG, Grignon A, Ouimet A. Blunt pancreatic injuries in children: the role of percutaneous external drainage in the treatment of pancreatic pseudocysts. J Pediatr Surg 1988;23:721–724.

    Article  CAS  PubMed  Google Scholar 

  45. Antillon MR, Shah RJ, Stiegmann G, Chen YK. Single-step EUS-guided transmural drainage of simple and complicated pancreatic pseudocysts. Gastrointest Endosc 2006;63:797–803.

    Article  PubMed  Google Scholar 

  46. Sanchez Cortes E, Maalak A, Le Moine O, Baize M, Delhaye M, Matos C, et al. Endoscopic cystenterostomy of nonbulging pancreatic fluid collections. Gastrointest Endosc 2002;56:380–386.

    Article  PubMed  Google Scholar 

  47. Jazrawi SF, Barth BA, Sreenarasimhaiah J. Efficacy of endoscopic ultrasound-guided drainage of pancreatic pseudocysts in a pediatric population. Dig Dis Sci 2011;56:902–908.

    Article  PubMed  Google Scholar 

  48. Eloubeidi MA, Chen VK, Eltoum IA, Jhala D, Chhieng DC, Jhala N, et al. Endoscopic ultrasound-guided fine needle aspiration biopsy of patients with suspected pancreatic cancer: diagnostic accuracy and acute and 30-day complications. Am J Gastroenterol 2003;98:2663–2668.

    PubMed  Google Scholar 

  49. Graham RA, Bankoff M, Hediger R, Shaker HZ, Reinhold RB. Fine-needle aspiration biopsy of pancreatic ductal adenocarcinoma: loss of diagnostic accuracy with small tumors. J Surg Oncol 1994;55:92–94.

    Article  CAS  PubMed  Google Scholar 

  50. Harewood GC, Wiersema MJ. Endosonography-guided fine needle aspiration biopsy in the evaluation of pancreatic masses. Am J Gastroenterol 2002;97:1386–1391.

    Article  PubMed  Google Scholar 

  51. Legmann P, Vignaux O, Dousset B, Baraza AJ, Palazzo L, Dumontier I, et al. Pancreatic tumors: comparison of dual-phase helical CT and endoscopic sonography. AJR Am J Roentgenol 1998;170:1315–1322.

    Article  CAS  PubMed  Google Scholar 

  52. Rosch T, Lightdale CJ, Botet JF, Boyce GA, Sivak MV Jr, Yasuda K, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med 1992;326:1721–1726.

    Article  CAS  PubMed  Google Scholar 

  53. Afify AM, al-Khafaji BM, Kim B, Scheiman JM. Endoscopic ultrasound-guided fine needle aspiration of the pancreas. Diagnostic utility and accuracy. Acta Cytol 2003;47:341–348.

    PubMed  Google Scholar 

  54. Wiersema MJ, Vilmann P, Giovannini M, Chang KJ, Wiersema LM. Endosonography-guided fine-needle aspiration biopsy: diagnostic accuracy and complication assessment. Gastroenterology 1997;112:1087–1095.

    Article  CAS  PubMed  Google Scholar 

  55. Sharp NE, Svetanoff WJ, Alemayehu H, Desai A, Raghavan MU, Sharp SW, et al. Lower radiation exposure from body CT imaging for trauma at a dedicated pediatric hospital. J Pediatr Surg 2014;49:1843–1845.

    Article  PubMed  Google Scholar 

  56. Miglioretti DL, Johnson E, Williams A, Greenlee RT, Weinmann S, Solberg LI, et al. The use of computed tomography in pediatrics and the associated radiation exposure and estimated cancer risk. JAMA Pediatr 2013;167:700–707.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Committee ASoP, Early DS, Acosta RD, Chandrasekhara V, Chathadi KV, Decker GA, et al. Adverse events associated with EUS and EUS with FNA. Gastrointest Endosc 2013;77:839–843.

    Article  Google Scholar 

  58. Wang KX, Ben QW, Jin ZD, Du YQ, Zou DW, Liao Z, et al. Assessment of morbidity and mortality associated with EUS-guided FNA: a systematic review. Gastrointest Endosc 2011;73:283–290.

    Article  PubMed  Google Scholar 

  59. Eisen GM, Baron TH, Dominitz JA, Faigel DO, Goldstein JL, Johanson JF, et al. Complications of upper GI endoscopy. Gastrointest Endosc 2002;55:784–793.

    Article  PubMed  Google Scholar 

  60. Silvis SE, Nebel O, Rogers G, Sugawa C, Mandelstam P. Endoscopic complications. Results of the 1974 American Society for Gastrointestinal Endoscopy Survey. JAMA 1976;235:928–930.

    CAS  PubMed  Google Scholar 

  61. Yoon WJ, Daglilar ES, Fernandez-del Castillo C, Mino-Kenudson M, Pitman MB, Brugge WR. Peritoneal seeding in intraductal papillary mucinous neoplasm of the pancreas patients who underwent endoscopic ultrasound-guided fine-needle aspiration: the PIPE Study. Endoscopy 2014;46:382–387.

    Article  PubMed  Google Scholar 

  62. Ngamruengphong S, Xu C, Woodward TA, Raimondo M, Stauffer JA, Asbun HJ, et al. Risk of gastric or peritoneal recurrence, and long-term outcomes, following pancreatic cancer resection with preoperative endosonographically guided fine needle aspiration. Endoscopy 2013;45:619–626.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Suril Patel.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Patel, S., Marshak, J., Daum, F. et al. The emerging role of endoscopic ultrasound for pancreaticobiliary diseases in the pediatric population. World J Pediatr 13, 300–306 (2017). https://doi.org/10.1007/s12519-017-0020-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-017-0020-y

Key words

Navigation