Endoscopic Point of Care Ultrasound: Foundations, Present Applications, Future Potentials

Abstract

Introduction: The present review details the evolution of endoscopic ultrasound, the acquisition of subepithelial imaging of the gastrointestinal tract during endoscopy, in pediatrics. Similar to its use in adults, the majority of its present applications involve obtaining fluid and or tissue for diagnosis. Simultaneously, the indications for point of care ultrasound, in which physicians caring for a patient personally obtains images which can be incorporated immediately into diagnosis and management, are also expanding. A history of endoscopic ultrasound from its inception to its current utilization is presented. The data reflecting its successful current employment  as the procedure of choice to analyze and drain pancreatic cysts, to diagnose biliary tract and pancreatic diseases, to direct subepithelial biopsies, and to evaluate gastrointestinal tumors as well as less common gastrointestinal pathologies, is summarized with an emphasis on pediatric studies. In addition, the recent expansion of point of care ultrasound and endoscopic ultrasound to yield images to analyze subepithelial pathology including fibrosis in eosinophilic esophagitis and in inflammatory bowel disease is highlighted. A brief summary of the challenges, range of instruments, costs, and safety provides the reader with the background to fully appreciate this emerging technique. Finally, there is an overview of exciting new developments that will further extend its indications. Conclusions: With anticipated improvements including better resolution of endoscopic ultrasound probes, the routine incorporation of point of care elastography and contrast enhanced ultrasound, and the potential of artificial intelligence to provide more reproducible and uniform analysis of endosonographic images, new indications are anticipated to enable endoscopic point of care ultrasound, E-POCUS, to further improve patient care in the near future