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Role of Endoscopic Ultrasound in Children

Agarwal, Jaya

Journal of Pediatric Gastroenterology and Nutrition: October 2017 - Volume 65 - Issue 4 - p e97
doi: 10.1097/MPG.0000000000001521
Letters to the Editor

Regency Health Care, Kanpur, India

Gordon et al (1) report on endoscopic ultrasound (EUS) as an emerging tool for pediatric pancreatobiliary disorders, reaffirming a prior report from Scheers et al (2). Some content of the newer study, however, needs clarification. Foremost is disagreement regarding the terminology “EUS-fine needle aspiration,” used by the authors for all the EUS-guided interventional procedures such as celiac plexus block or pancreatic fluid collection drainage (3,4). If fine needle aspiration alone was done for pancreatic fluid collection or pseudocyst without any EUS-guided drainage, then its clear indication should be specified, as aspiration alone is usually inappropriate. The new finding that the present study adds according to the authors is the role of EUS in delineating mucosal gastrointestinal disease. I found only 1 case of gastrointestinal stromal tumors of the 43 cases that could support their statement. Utility of EUS in diagnosis of pyloric stenosis in infants is questionable compared with high-resolution ultrasound alone except in rare cases (5). Considering the thin abdominal wall of infants, EUS seems to have no advantage over conventional ultrasound, which is less invasive. It is unlikely in the present study that an infant with suspected pyloric stenosis was taken directly to endoscopy and then EUS without an abdominal ultrasound, a detail that was not specified. On careful analysis of the Table 1, the statement “EUS led to new diagnosis in 34 of the 43 patients” appears to be exaggerated. Moreover authors do not discuss how EUS may affect outcomes including any changes in management.

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1. Gordon K, Conway J, Evans J, et al. EUS and EUS-guided interventions alter clinical management in children with digestive diseases. J Pediatr Gastroenterol Nutr 2016; 63:242–246.
2. Scheers I, Ergun M, Aouattah T, et al. Diagnostic and therapeutic roles of endoscopic ultrasound in pediatric pancreaticobiliary disorders. J Pediatr Gastroenterol Nutr 2015; 61:238–247.
3. Ramesh J, Bang JY, Trevino J, et al. Endoscopic ultrasound-guided drainage of pancreatic fluid collections in children. J Pediatr Gastroenterol Nutr 2013; 56:30–35.
4. 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.
5. Khan K. High-resolution EUS to differentiate hypertrophic pyloric stenosis. Gastrointest Endosc 2008; 67:375–376.
© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,