scholarly journals EUS in Pediatrics: A Multicenter Experience and Review

2021 ◽  
Vol 9 ◽  
Author(s):  
Travis L. Piester ◽  
Quin Y. Liu
Keyword(s):  
Literature Review ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Technical Success ◽  
Pancreatic Fluid ◽  
Therapeutic Uses ◽  
Wide Range ◽  
Fluid Collections ◽  
Tertiary Care Centers

Background/Aim: Endoscopic ultrasound (EUS) is a well-established tool used in the evaluation and treatment of a wide range of pathologies in adult medicine. EUS in pediatrics has been shown to be safe and technically effective, and its use continues to evolve. This article aims to describe the EUS experience at our tertiary-care centers with regard to safety, technical success, and its impact in clinical management. We also discuss the current and developing diagnostic and therapeutic uses for EUS in pediatrics such as in pancreaticobiliary disease, congenital anomalies, eosinophilic esophagitis, inflammatory bowel disease, and liver disease.Methods: This is a retrospective review of EUS performed by two pediatric gastroenterologists trained as endosonographers between April 2017 and November 2020. Patient demographics, procedure indication, procedure characteristics, technical success, and complications were collected. Literature review was performed to describe current and future uses of EUS in pediatrics.Results: Ninety-eight EUS were performed with 15 (15.3%) including fine needle aspiration/biopsy and 9 (9.2%) cases being therapeutic. Most common indications include choledocholithiasis (n = 31, 31.6%), pancreatic fluid collections (n = 18, 18.4%), chronic and acute recurrent pancreatitis (n = 14, 14.3%), and acute pancreatitis characterization (n = 13, 13.3%). Notable indications of pancreatic mass (n = 6, 6.1%) and luminal lesions/strictures (n = 6, 6.1%) were less common. Complications were limited with one instance of questionable GI bleeding after cystgastrostomy creation. Ninety-eight of 98 (100%) cases were technically successful.Conclusion/Discussion: EUS has been shown to be performed safely and successfully in the pediatric population by pediatric endosonographers. This study and review support its use in pediatric practice and demonstrate the wide variety of indications for EUS such as pancreatic cystgastrostomy, celiac plexus neurolysis, and evaluation of chronic pancreatitis. This literature review also demonstrates areas of potential development for EUS within the practice of pediatric gastroenterology.

scholarly journals Outcomes of a single-step endoscopic ultrasound-guided drainage of pancreatic-fluid collections using an electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent with and without fluoroscopy

2020 ◽  
Author(s):  
Babatunde Olaiya ◽  
Parit Mekaroonkamol ◽  
Bai-Wen Li ◽  
Julia Massaad ◽  
Cicily T Vachaparambil ◽  
...  
Keyword(s):  
Clinical Success ◽  
Stent Migration ◽  
Single Step ◽  
Success Rates ◽  
Metal Stent ◽  
Technical Success ◽  
Pancreatic Fluid Collections ◽  
Pancreatic Fluid ◽  
The Mean ◽  
Fluid Collections

Abstract Background Fluoroscopy is often used during the endoscopic drainage of pancreatic-fluid collections (PFCs). An electrocautery-enhanced coaxial lumen-apposing, self-expanding metal stent (ELAMS) facilitates a single-step procedure and may avoid the need for fluoroscopy. This study compares the treatment outcomes using ELAMS with and without fluoroscopy. Methods Patients with PFCs who had cystogastrostomy from January 2014 to February 2017 were enrolled. Two groups were studied based on fluoroscopy use. Technical success was defined as uneventful insertion of ELAMS at time of procedure. Clinical success was defined as (i) clinical resolution of symptoms after the procedure and (ii) >75% reduction in cyst size on computed tomography 8 weeks after stent placement. Adverse events including bleeding, stent migration, and infection were recorded. Results A total of 21 patients (13 males) had PFCs drainage with ELAMS in the study period. The mean age was 51.6 ± 14.2 years. Thirteen patients had walled-off necrosis while eight had a pancreatic pseudocyst. The mean size of the PFCs was 11.3 ± 3.3 cm. Fluoroscopy was used in seven cases (33%) and was associated with a longer procedure time compared to non-fluoroscopy (43.1 ± 10.4 vs 33.3 ± 10.5 min, P = 0.025). This association was independent of the size, location, or type of PFCs. Fluoroscopy had no effect on the technical success rates. In fluoroless procedures, the clinical resolution was 91% as compared to 71% in fluoroscopy procedures (P = 0.52) and the radiologic resolution was 57% as compared to 71% in fluoroscopy procedures (P = 0. 65). Three cases of stent migration/displacement occurred in the fluoroless procedures. Conclusions ELAMS may avoid the need for fluoroscopy during cystogastrostomy. Procedures without fluoroscopy were significantly shorter and fluoroscopy use had no impact on the technical or clinical success rates.

scholarly journals Overestimation of the prevalence of eosinophilic colitis with reliance on a single billing code

2018 ◽  
Author(s):  
AB Muir ◽  
ET Jensen ◽  
JB Wechsler ◽  
P Menard-Katcher ◽  
GW Falk ◽  
...  
Keyword(s):  
Chart Review ◽  
Gastrointestinal Disease ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Bloody Stool ◽  
Eosinophilic Colitis ◽  
Billing Code ◽  
Icd Codes ◽  
Tertiary Care Centers ◽  
Multi Center Study

AbstractEosinophilic colitis (EC) is a rare disorder characterized by eosinophilic inflammation of the colon causing diarrhea, bloody stool, nausea, constipation and abdominal pain. The Consortium for Eosinophilic Gastrointestinal Disease Research sought to undertake the first multi-center study of the EC population, but faced challenges with meeting enrollment goals that were based on initial estimates. To understand the reason for this, we performed chart review of patients with ICD codes for EC at 8 tertiary care centers. Chart review revealed that the isolated use of ICD codes overestimated EC rates in the pediatric population.

Lumen-apposing stents versus plastic stents in the management of pancreatic pseudocysts: a large, comparative, international, multicenter study

Endoscopy ◽  
2018 ◽  
Vol 51 (11) ◽  
pp. 1035-1043 ◽  
Author(s):  
Juliana Yang ◽  
Yen-I Chen ◽  
Shai Friedland ◽  
Ian Holmes ◽  
Christopher Paiji ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Success ◽  
Length Of Hospital Stay ◽  
Plastic Stents ◽  
Pancreatic Pseudocysts ◽  
Technical Success ◽  
Pancreatic Fluid ◽  
International Multicenter Study ◽  
Fluid Collections

Abstract Background Larger caliber lumen-apposing stents (LAMSs) have been increasingly used in the management of pancreatic fluid collections, specifically when solid debris is present; however, their advantages over smaller caliber plastic stents in the management of pancreatic pseudocysts are unclear. The aim of this study was to investigate the safety and efficacy of LAMS specifically in the management of pancreatic pseudocysts compared with double-pigtail plastic stents (DPPSs). Methods We performed a multicenter, international, retrospective study between January 2012 and August 2016. A total of 205 patients with a diagnosis of pancreatic pseudocysts were included, 80 patients received LAMSs and 125 received DPPSs. Measured outcomes included clinical success, technical success, adverse events, stent dysfunction, pancreatic pseudocyst recurrence, and need for surgery. Results Technical success was similar between the LAMS and the DPPS groups (97.5 % vs. 99.2 %; P = 0.32). Clinical success was higher for LAMSs than for DPPSs (96.3 % vs. 87.2 %; P = 0.03). While the need for surgery was similar between the two groups (1.3 % vs. 4.9 %, respectively; P = 0.17), the use of percutaneous drainage was significantly lower in the LAMS group (1.3 % vs. 8.8 %; P = 0.03). At 6-month follow-up, the recurrence rate was similar between the groups (6.7 % vs 18.8 %, respectively; P = 0.12). The rate of adverse events was significantly higher in the DPPS group (7.5 % vs. 17.6 %; P = 0.04). There was no difference in post-procedure mean length of hospital stay (6.3 days [standard deviation 27.9] vs. 3.7 days [5.7]; P = 0.31). Conclusion When compared to DPPSs, LAMSs are a safe, feasible, and effective modality for the treatment of pancreatic pseudocysts and are associated with a higher rate of clinical success, shorter procedure time, less need for percutaneous interventions, and a lower overall rate of adverse events.

scholarly journals Evaluation of thyroid nodule in pediatric population in a tertiary care hospital

2019 ◽  
Vol 6 (5) ◽  
pp. 2152
Author(s):  
Mukul Singh ◽  
Manju Kumari
Keyword(s):  
Thyroid Nodule ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Adult Population ◽  
Tertiary Care ◽  
Needle Aspiration ◽  
Care Hospital ◽  
Pediatric Age Group ◽  
Thyroid Cytopathology ◽  
Rule Out

Background: Thyroid nodules are commonly present in adult population but are rare in pediatric age group. Inspite of being rare, thyroid nodule have a higher chance of malignancy in children. Thus, pediatric patients presenting with thyroid nodule found clinically or incidentally should be worked up to rule out any possibility of malignancy. The besthesda system for reporting thyroid cytopathology (TBSRTC) is widely used for reporting in adults. The present study aims to use TBSRTC for pediatric thyroid lesions reporting.Methods: All pediatric patients with age ≤ 18 years presenting with thyroid nodule during January 2018 to April 2019 were included in the study, fine needle aspiration (FNA) was done and findings were compared with histology. Statistical analysis was done using SPSS version 18.Results: 42 pediatric patient were included in the study, out of which 2.38% were malignant and suspicious for nmalignant each and 83% were benign.Conclusion: TBSRTC is quite sensitive and specific reporting guideline in pediatric population as in adult population with 100% accuracy in diagnosing benign and malignant cases. This is useful for avoiding unnecessary surgeries.

Penetrating knife injury to the skull: A case report in pediatric neurosurgical care

Trauma ◽  
2016 ◽  
Vol 19 (4) ◽  
pp. 302-307
Author(s):  
Tene A Cage ◽  
Nader Sanai ◽  
Michael T Lawton ◽  
Kurtis I Auguste
Keyword(s):  
Pediatric Population ◽  
Tertiary Care ◽  
Interdisciplinary Team ◽  
Brain Parenchyma ◽  
Cerebral Vasculature ◽  
Local Trauma ◽  
Tertiary Care Centers ◽  
Knife Injury ◽  
Neurologically Intact ◽  
The Brain

Isolated penetrating head injury in children is rare and is usually accidental. Each case is unique since the penetrating object and the trajectory through the brain parenchyma vary greatly among patients. We present a three-year-old girl who presented with a kitchen utility knife penetrating her left midface, skull, and brain abutting the anterior cerebral vasculature. Though the patient initially presented to a local trauma center, there were no pediatric nor vascular neurosurgeons on staff. Thus, she was transferred to our tertiary facility for definitive surgical management. A pediatric and vascular neurosurgeon worked together to remove the knife safely and the underlying vasculature remained intact. Postoperatively, the patient did well and was neurologically intact. Though penetrating cranial injury is rare in the pediatric population, such complex cases of brain injury can be properly managed with good outcome by an interdisciplinary team of specialists in tertiary care centers and can result in an excellent surgical and functional outcome for the patient.

scholarly journals Thaalisapaththiri Chooranam (Poly Herbal Formulation) in Siddha Medicine - A literature review

2020 ◽  
Vol 11 (1) ◽  
pp. 23-29
Author(s):  
Musthafa Mufaza ◽  
Hasim Nisra ◽  
Kalaichelvi Sounthararajan ◽  
Vinotha Sanmugarajah
Keyword(s):  
Literature Review ◽  
Respiratory Tract ◽  
Health Management ◽  
Volatile Oil ◽  
Preliminary Step ◽  
Herbal Formulation ◽  
Therapeutic Uses ◽  
Wide Range

Thaalisapaththiri chooranam (T.C) is a poly herbal formulation and used to treat a wide variety of respiratory tract conditions such as kaasam, shayam, eilai and pitha diseases in Siddha Medicine. It has different ingredients which are having a wide range of therapeutic uses. Although the method of preparation of the T.C is mentioned in the eight text books, same variety of ingredients (eighteen) is mentioned in only two books. Therefore, the preliminary step was to develop the documentary evidences for the medicinal ingredients those are using to prepare the T.C. Data for the review on 18 ingredients from 13 families were collected from relevant text books and research sources from October to December 2019. The characteristics of the ingredients that were identified for the review were morphology; native; parts used; siddha properties such as taste, potency and efficacy; pharmacological actions and phytochemicals. Among these ingredients, all were identified as herbal materials and 2(11.1%) of the species were found in Umbelliferae, Myristicaceae, Piperaceae, Combretaceae and Compositae families. Based on the morphology 8(44.44%) and 6(33.33%) plants were trees and herbs respectively; 8 species (44%) were used as dry fruits. Among these ingredients, 11(39.2%) were pungent in taste, 15(83.3%) hot potency and 12(66%) pungent efficacy. Based on pharmacological actions such as carminative [12(27%)] and stimulant [11(23%)]; phytochemicals such as volatile oil 8(23%) were found in these ingredients. Although this review provides useful documentary evidences for T.C in health management further extensive scientific studies should be carried out to justify in future.

Snare-tip soft coagulation is effective and efficient as a first-line modality for treating intraprocedural bleeding during Barrett’s mucosectomy

Endoscopy ◽  
2020 ◽  
Author(s):  
Sergei Vosko ◽  
Sunil Gupta ◽  
Neal Shahidi ◽  
Luke F. Hourigan ◽  
W. Arnout van Hattem ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Technical Success ◽  
First Line ◽  
Intention To Treat ◽  
Primary Hemostasis ◽  
First Line Therapy ◽  
Line Therapy ◽  
Soft Coagulation ◽  
Tertiary Care Centers ◽  
Multiband Mucosectomy

Background Intraprocedural bleeding (IPB) during multiband mucosectomy (MBM) for Barrett’s neoplasia can obscure the endoscopic field. Current hemostatic devices may affect procedure continuity and technical success. Snare-tip soft coagulation (STSC) as a first-line therapy for primary hemostasis has not previously been studied in this setting. Methods Between January 2014 and November 2019, 191 consecutive patients underwent 292 MBM procedures for Barrett’s neoplasia within a prospective observational cohort in two tertiary care centers. A standard MBM technique was performed. IPB was defined as bleeding obscuring the endoscopic field that required intervention. The primary outcome was the technical success and efficacy of STSC. Results IPB occurred in 63 MBM procedures (21.6 %; 95 % confidence interval 17.3 % – 26.7 %). STSC was attempted as first-line therapy in 51 IPBs, with the remainder requiring alternate therapies because of pooling of blood. STSC achieved hemostasis in 48 cases (94.1 % by per-protocol analysis; 76.2 % by intention-to-treat analysis). No apparatus disassembly was required to perform STSC. Conclusions STSC is a safe, effective, and efficient first-line hemostatic modality for IPB during MBM for Barrett’s neoplasia.

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