Endoscopic ultrasound (EUS) emerged as a revolutionary intervention, serving both diagnostic and therapeutic purposes for more than four decades among adult patients, however utility in paediatric patients remained limited due to EUS endoscope design e.g. rigidity, diameter, traumatic distal tip, furthermore complicated by need of Monitored Anesthesia Care(MAC) or General Anesthesia(GA). Fewer studies with smaller data have been conducted for EUS effectiveness and safety among children. This article aims to describe the utility of EUS for diagnostic and therapeutic purposes among children at one of the largest referral endoscopy unitsin Pakistan. 

Retrospective analysis of EUS for patients ≤ 18 years of age, performed at single referral endoscopy center over 18 years, from 2007 to 2024. Data was collected from the institute’s database. 

All the procedures were performed by endoscopist who bear certified training of endoscopic ultrasound. Linear array Echoendoscope and Radial Echoendoscopes were used. A total of 124 patients ≤ 18 years age had EUS, the youngest was 5 years old with mean age of 14.75 ± 3.21years. 54% were male gender. Primary indications for EUS examination included: 18 chronic pancreatitis, 38 pancreatic pseudocyst, 12 pancreatic mass, 4 suspected choledochal cyst, 7 patients with abdominal lymph nodes, 2 retroperitoneal lesions and 1 lesser sac lesion, 21 gastrointestinal tract lesions,. 90 EUS were performed for diagnostic purpose, 17 patients underwent FNB and 4 underwent FNA. Among Therapeutic EUS, 23 patients underwent EUS guided pseudocyst drainage, 2 patients underwent celiac plexus block referred for pain management of chronic pancreatitis, one patient underwent EUS guided pancreatic duct cannulation with stent placement and one patient underwent EUS guided anterograde rendezvous’ technique- choledocoduodenostomy for choledochal cyst. All therapeutic procedures were performed under general anesthesia whereas diagnostic EUS were performed under monitored anesthesia care. No immediate or early complications were seen.

In this modern era of advanced diagnostic tools and minimally invasive interventions, EUS related procedures are safe and effective in pediatric group of patients too. However, this procedure should be performed at specialized centers with experienced pediatric anesthesia team.