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Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Orlando, October 22-24, 1998


Fox, V; Heard, L; Donovan, K

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Journal of Pediatric Gastroenterology & Nutrition: October 1998 - Volume 27 - Issue 4 - p 476
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Abstract 54

Conventional endoscopic ultrasonography (EUS) is potentially difficult or impossible to perform in small children due to the relatively large diameter of currently designed echoendoscopes. In contrast, ultrasound probes can be inserted through the operating channel of pediatric-size endoscopes permitting examination of virtually any child. The feasibility of EUS in children has not been previously investigated. We report our initial experience with high frequency probe ultrasonography (HFPU) in children. Methods: Selected patients undergoing scheduled upper gastrointestinal endoscopy were enrolled after obtaining hospital IRB-approved consent. The Olympus EU-M20 ultrasound processor and 20 MHz (UM-3R) mechanical, radial scanning probe (2.5mm diameter) were used. Probes were passed through a GIF PQ20 or GIF100 gastroscope (2.8mm channel). Videotaped HFPU was performed after initial endoscopic visual inspection and prior to mucosal biopsy. Water was carefully infused into the lumen for acoustic contact. If sedation was suboptimal, the study was aborted to avoid aspiration. Patient demographics, clinical diagnosis, sedation, duration, esophageal and gastric wall thickness and number of visualized echo layers, extramural structures, and complications were noted. Results: Ten patients were enrolled, age range 2-15 yr. Diagnoses included dysphagia (n=3), allergic esophagitis (n=2), GER (n=2), eosinophilic gastroenteritis (n=1), achalasia (n=1), and abdominal pain (n=1). Sedation was IV (n=6) and general anesthesia (n=4). Mean exam duration was 16 min. (range 5-24 min.). Seven echo layers were seen in all cases. Wall thickness ranged from 2-5mm for esophagus and 2-3mm for stomach, increasing with patient age. The thoracic aorta was seen universally and other commonly seen structures included azygous vein, lymph nodes, splenic and portal veins, pancreas, and pancreatic duct. Examinations were completed in 8/10 enrolled patients. There were no complications. Conclusion: HFPU provides detailed imaging of the gastrointestinal wall and some deeper structures in children and may be performed safely in a well-sedated child at the time of routine endoscopy. The clinical utility for this technology in children remains to be defined.

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© 1998 Lippincott Williams & Wilkins, Inc.