After

EUS TCB diagnosis of type 2 AIP, prednisone therapy was administered in 4 patients (patients 1, 2, 6, and 7), resulting in complete clinical resolution without recurrence over a mean follow-up of 22 months (range, 1.5-54 months). Three patients (patients 4, 8, and 9) with AIP were not given steroids due to insufficient disease severity. Of these, 1 patient (patient 4) remains under close supervision at our facility, whereas the other 2 are being followed by their referring institution. The use of TCB in the pediatric patient population has been limited http://www.selleckchem.com/products/PD-0325901.html by a difficult-to-use TCB needle, smaller pancreas size in children, relative paucity of indications, uncertain role of TCB, and heightened concern regarding its safety in pediatric patients. Our data, however, suggest the potential utility and safety of EUS TCB in a pediatric population. The diagnostic yield of EUS TCB in our patient population was 86%, which is comparable with that reported in adults.2, 9, 10 and 11 Only 1 check details patient with AIP had nondiagnostic pathology, but the EUS imaging features suggested the diagnosis of AIP, which had not been previously suspected. The EUS TCB diagnosis of AIP significantly altered the management of our patients, leading directly to steroid therapy in most. For the 3 patients with AIP and mild symptoms,

the ability to obtain a definitive diagnosis now allows careful monitoring and disease-specific therapy if subsequently clinically required. In these patients, we opted to obtain TCB specimens to optimize the chance for diagnosis given the lower diagnostic sensitivity of EUS TCB when obtained after steroid therapy or during later disease stages. Early diagnosis of pancreatic pathology, especially AIP,

allows for timely and disease-specific therapy Wilson disease protein and may help prevent disease progression to advanced usual chronic pancreatitis. Histologic confirmation also avoids the risks associated with indiscriminate steroid therapy for incorrectly presumed AIP. The diagnosis of AIP, although always challenging, is particularly difficult among pediatric patients given their tendency for type 2 disease. Type 2 AIP was the most common diagnosis in this patient population, as opposed to type 1 AIP, which accounts for 80% of AIP in the general U.S. population.12 Type 2 AIP is typically found in younger patients than type 1 AIP, but AIP in general is thought to be uncommon in the pediatric population.13 Diagnosis of type 2 AIP requires histologic confirmation, which was achieved in 86% of our pediatric patients using EUS TCB.14 Our experience also suggests the potential under-recognition of this disease, especially in the pediatric population, may be in part due to the reluctance to obtain histologic verification. However, our study suggests that EUS TCB may be a safe and feasible diagnostic tool for AIP in children in the appropriate clinical setting.