Normal Endoscopic Ultrasound (EUS) Values in Children: 385

Introduction: Endoscopic ultrasound (EUS) has been employed to measure esophageal wall thickness (TWT) in eosinophilic esophagitis (EoE). Increases in TWT have been shown to be a marker of esophageal remodeling in EoE. In order to establish baseline values in Pediatrics, EUS measurements of TWT in children without EoE are presented.FigureMethods: NIneteen patients (12M; 9.0±6.5y; range: 0.6-20.9y) with clinical symptoms suggestive of esophageal dysfunction were part of an IRB approved research study on EoE. All 19 had upper endoscopy followed by EUS and biopsies from the mid and distal (dis) esophagus. Only those without any endoscopic or histologic features of EoE are included in the present analysis. Fifteen had clinical GERD. Four were follow up EoE patients who had been effectively treated, yielding no symptoms and no esophageal eosinophilia for >1 year. The maximum eos/hpf in this cohort was 4; most had none. A 20MHz EUS miniprobe measured TWT in the dis and mid esophagus, followed by biopsies from the same two sites. Results: TWT correlated with age, height, and BMI in both the mid and distal esophagus. The average TWT of the mid (1.57mm) and dis (1.55mm) were not statistically different (P=0.2). For both the mid and dis TWT, the values obtained in this cohort were overall less than the patients enrolled in the study with active EoE (but the difference was limited to the older, larger patients). Linear best fit approximations of predicted TWT were generated for each variable (Figure shows for height). The coefficient of determinations (R2), indicates that the height of the patient (0.57 dist, 0.53 mid) provides a more accurate estimate of TWT than the age (0.34 dist, 0.47 mid) or BMI (0.09 dist, 0.07 mid). Conclusion: EUS permits detailed analysis and measurements of the esophageal TWT. It is imperative to have baseline values through childhood to determine if younger children with EoE are also experiencing an increase in TWT. Our data cannot be unequivocally representative of normal children, as it would not be ethical to sedate and study a completely asymptomatic cohort of children. The presented data demonstrates that among non EoE children, as they get older and larger their esophageal wall thickens. The EUS measurements in this cohort are in the range of published values obtained by various methods. In conclusion, TWT in normal children correlates best with their height. Preliminary data is presented that can be employed to estimate baseline TWT based on a child's height.