Impacto da ecoendoscopia diagnóstica e intervencionista em crianças e adolescentes
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Data
2023-09-04
Autores
Garcia, Larissa Latrilha [UNIFESP]
Orientadores
Ardengh, José Celso
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A ecoendoscopia faz parte da prática clínica diária para o diagnóstico e tratamento de doenças digestivas em adultos. No entanto, seu uso em crianças é limitado, com indicações precisas. O medo é maior em relação ao uso da ecoendoscopia associada a punção com agulha fina em crianças.
Objetivos: O objetivo desse estudo foi avaliar o impacto da ecoendoscopia-diagnóstica (EE-D) e da ecoendoscopia-intervencionista (EE-I) em crianças.
Métodos: Revisamos os prontuários de crianças com idade menor ou igual a 18 anos submetidas à ecoendoscopia alta (102) e baixa (5), por um período de 10 anos. Analisamos retrospectivamente as indicações, resultados, segurança e o impacto da ecoendoscopia-diagnóstica (EE-D) e ecoendoscopia-intervencionista (EE-I). O impacto foi classificado como forte, fraco e ausente.
Resultados: 107 crianças foram submetidas à ecoendoscopia, 77 meninas (72%), com média etária de 11,7 + 4 anos (5-18). 64 (58%) foram submetidas à EE-D e 43 (42%) a EE-I. Dessas, 33 (77%) foram submetidas à ecoendoscopia associada a punção com agulha fina (EE-PAF) e 10 (33%) à terapêutica associada a ecoendoscopia [pseudocistos pancreáticos (5), necrose encistada pancreática (2), abscesso perirretal (1) e neurólise do plexo celíaco (2)] A taxa de sucesso técnico, clínico e de eventos adversos para a EE-I foi de 100%, 90% e 0%, respectivamente. O sistema biliopancreático foi estudado em 81 (76%), estômago 14 (13%), reto 5 (4,6%), esôfago 3 (2,8%), duodeno 2 (1,8%) e mediastino 2 (1,8%) casos. O impacto foi significativo em 81% dos casos. O impacto foi forte e fraco para os casos biliopancreáticos, gastrointestinais e mediastinais em 62% e 16%, 54% e 37% e 100% e 0%, respectivamente. Os resultados obtidos pela ecoendoscopia associada a punção com agulha fina (EE-PAF) mostraram sensibilidade, especificidade e acurácia de 76,2%, 100% e 84,8%, respectivamente.
Conclusão: A EE-D e a EE-I são eficazes e seguras quando indicadas corretamente para doenças digestivas em crianças. A ecoendoscopia associada a punção com agulha fina (EE-PAF) é um procedimento altamente preciso e esclarece casos duvidosos, determinando o diagnóstico correto das doenças digestivas. O impacto foi significativo, pois altera o diagnóstico e o manejo subsequente na maioria das crianças com distúrbios gastrointestinais.
Introduction: Endosonography (EUS) is part of a daily clinical practice in the diagnosis and treatment of digestive diseases in adults. However, it is use in children is limited. The fear is grest of use the endosonography-guided fine needle aspiration (EUS-FNA) in children. Aims: The aims of this study were to evaluate the impact of diagnostic (D-EUS) and interventional-endosonography (I-EUS) in children. Methods: We reviewed the medical records of children <18 years old submitted to upper EUS (102) and lower EUS (5), over a 10-year period. We retrospectively analyzed the indications, results, safety, and impact of D-EUS and I-EUS. The impact was classified as strong, weak, and absent. Results: 107 children underwent to EUS, 77 girls (72%), average age 11.7 + 4 years (5-18). 64 (58%) to D-EUS and 43 (42%) to I-EUS. In the I-EUS 33 (77%) were submitted to EUS-FNA in and 10 (33%) to therapeutic EUS [pancreatic pseudocysts (5), walled off necrosis (2), perirectal abscess (1), and celiac plexus neurolysis (2)]. Technical, clinical success and adverse event rate for I-EUS was 100%, 90% and 0%, respectively. The biliopancreatic system was studied in 81 (76%) cases, stomach 14 (13%), rectum 5 (4.6%), esophagus 3 (2.8%), duodenum 2 (1.8%) and mediastinum 2 (1.8%). The impact was significant in 81%. The impact was strong and weak for biliopancreatic, gastrointestinal and mediastinal in 62% and 16%, 54% and 37% and 100% and 0%, respectively. The results obtained by EUS-FNA showed sensitivity, specificity, and accuracy 76.2%, 100% and 84.8%, respectively. Conclusion: The D-EUS and I-EUS are effective and safe when correctly indicated for digestive diseases. The EUS-FNA is highly accurate procedure and can clear up doubtful cases, determining the accurate diagnosis of digestive diseases. The impact was significant that alters subsequent diagnosis and management in most children with gastrointestinal disorders.
Introduction: Endosonography (EUS) is part of a daily clinical practice in the diagnosis and treatment of digestive diseases in adults. However, it is use in children is limited. The fear is grest of use the endosonography-guided fine needle aspiration (EUS-FNA) in children. Aims: The aims of this study were to evaluate the impact of diagnostic (D-EUS) and interventional-endosonography (I-EUS) in children. Methods: We reviewed the medical records of children <18 years old submitted to upper EUS (102) and lower EUS (5), over a 10-year period. We retrospectively analyzed the indications, results, safety, and impact of D-EUS and I-EUS. The impact was classified as strong, weak, and absent. Results: 107 children underwent to EUS, 77 girls (72%), average age 11.7 + 4 years (5-18). 64 (58%) to D-EUS and 43 (42%) to I-EUS. In the I-EUS 33 (77%) were submitted to EUS-FNA in and 10 (33%) to therapeutic EUS [pancreatic pseudocysts (5), walled off necrosis (2), perirectal abscess (1), and celiac plexus neurolysis (2)]. Technical, clinical success and adverse event rate for I-EUS was 100%, 90% and 0%, respectively. The biliopancreatic system was studied in 81 (76%) cases, stomach 14 (13%), rectum 5 (4.6%), esophagus 3 (2.8%), duodenum 2 (1.8%) and mediastinum 2 (1.8%). The impact was significant in 81%. The impact was strong and weak for biliopancreatic, gastrointestinal and mediastinal in 62% and 16%, 54% and 37% and 100% and 0%, respectively. The results obtained by EUS-FNA showed sensitivity, specificity, and accuracy 76.2%, 100% and 84.8%, respectively. Conclusion: The D-EUS and I-EUS are effective and safe when correctly indicated for digestive diseases. The EUS-FNA is highly accurate procedure and can clear up doubtful cases, determining the accurate diagnosis of digestive diseases. The impact was significant that alters subsequent diagnosis and management in most children with gastrointestinal disorders.
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Citação
GARCIA, Larissa Latrilha. Impacto da ecoendoscopia diagnóstica e intervencionista em crianças e adolescentes. 2023. 76 f. Dissertação (Mestrado em Radiologia Clínica) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.