Varadarajulu Shyam, Wilcox C Mel, Eloubeidi Mohamad A
Division of Gastroenterology-Hepatology, University of Alabama at Birmingham, 35294, USA.
Gastrointest Endosc. 2005 Aug;62(2):239-44. doi: 10.1016/s0016-5107(05)00312-3.
While the role of EUS in the evaluation of pancreaticobiliary (PB) disorders in adults is well established, its utility in children remains unproven. This prospective study evaluates the feasibility, the safety, and the impact of EUS in the evaluation of PB disorders in children.
All children (<18 years) referred for ERCP for evaluation of suspected PB disorders who underwent EUS before scheduled ERCP. The main outcome measure was to evaluate the impact of EUS in the evaluation of PB disorders in children. EUS was considered to have a significant impact if a new diagnosis was established or if the findings altered subsequent management.
Fourteen patients (mean age 13 years; range 5-17 years) underwent 15 EUS procedures over a 3-year period. Main indications were the following: acute or recurrent pancreatitis (6 patients), suspected biliary obstruction (5), and abdominal pain suggestive of PB origin (3). EUS diagnosed chronic pancreatitis (3 patients), idiopathic fibrosing pancreatitis (2), carcinoid tumor (1), pancreatic pseudocyst (1), pancreas divisum (1), choledocholithiasis (1), duodenal duplication cyst (1), and normal (4). Diagnosis of idiopathic fibrosing pancreatitis and carcinoid tumor was established by EUS-guided FNA. The procedure was successful in all patients, and no complications were encountered. EUS had an impact on patient management in 93% of cases: established new diagnosis (10), precluded need for ERCP (9), and provided additional information that facilitated focused endotherapy (4). A limitation was the small number of enrolled patients and absence of long-term clinical follow-up.
EUS and EUS-guided FNA are feasible, safe, and have significant impact that alters subsequent management in the majority of children with PB disorders. Further studies and dissemination of information is required to facilitate its increased application in children.
虽然超声内镜（EUS）在评估成人胰胆（PB）疾病中的作用已得到充分确立，但其在儿童中的效用仍未得到证实。这项前瞻性研究评估了EUS在评估儿童PB疾病中的可行性、安全性及影响。
所有因疑似PB疾病而转诊进行内镜逆行胰胆管造影（ERCP）评估的儿童（<18岁），在预定的ERCP之前接受了EUS检查。主要结局指标是评估EUS在评估儿童PB疾病中的影响。如果建立了新的诊断或检查结果改变了后续治疗，则认为EUS有显著影响。
在3年期间，14例患者（平均年龄13岁；范围5 - 17岁）接受了15次EUS检查。主要适应证如下：急性或复发性胰腺炎（6例）、疑似胆道梗阻（5例）、提示PB起源的腹痛（3例）。EUS诊断出慢性胰腺炎（3例）、特发性纤维性胰腺炎（2例）、类癌肿瘤（1例）、胰腺假性囊肿（1例）、胰腺分裂症（1例）、胆总管结石（1例）、十二指肠重复囊肿（1例），以及正常情况（4例）。特发性纤维性胰腺炎和类癌肿瘤的诊断通过EUS引导下细针穿刺活检（FNA）确立。该检查在所有患者中均成功，且未出现并发症。EUS在93%的病例中对患者治疗产生了影响：建立了新的诊断（10例）、避免了ERCP的需要（9例），并提供了有助于进行针对性内镜治疗的额外信息（4例）。一个局限性是入组患者数量少且缺乏长期临床随访。
EUS及EUS引导下FNA是可行、安全的，并且对大多数患有PB疾病的儿童的后续治疗有显著影响。需要进一步研究和信息传播以促进其在儿童中的更多应用。
