Endoscopic Ultrasonography in Children with Eosinophilic Esophagitis—A Review

Endoscopic ultrasonography (EUS) is a diagnostic endoscopy of the upper gastrointestinal tract, during which ultrasound of nearby organs is also performed. It is also possible to perform a fine needle aspiration biopsy. Currently, EUS is performed more frequently in adults. Despite some limitations, this diagnostic method is also more and more often performed in pediatric patients. Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus, which also occurs in children, and leads to irreversible fibrosis of the esophagus wall, if left untreated. Traditional methods of diagnosing and monitoring EoE treatment have significant limitations, and the use of EUS and total esophageal wall thickness (TWT) assessment may bring measurable benefits. Several studies have shown an increased thickening of TWT in EoE in children compared to pediatric patients with gastroesophageal reflux disease, and a decrease in TWT in adults who responded to EoE treatment. These results suggest that EUS and TWT measurement may become an important test in diagnostics, monitoring the effectiveness of therapy, assessing disease progression, and in individualizing the method and duration of EoE treatment also in children.

Endoscopic Ultrasonography-Specific Stents

The evolution of the endoscopic ultrasonography (EUS) technique has necessitated the development of EUS-specific accessories and stents. In the earlier period, EUS-guided interventions mostly relied on borrowed accessories and stents from therapeutic endoscopy in particular ERCP. Traditional stents do not serve the purpose of EUS-guided transluminal stenting in all cases due to the length of the stent, no anchoring mechanism, and chance of migration. From 2011 onward, several EUS-specific stents became available, bringing a paradigm shift in interventional EUS. This article reviews current EUS-specific stents, indications, strengths, and weaknesses.