Manual Practical Pediatric Gastrointestinal Endoscopy

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Pediatric Gastrointestinal Endoscopy Textbook and Atlas

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Alexa Actionable Analytics for the Web. On the other hand, deep sedation provides a more reliable state of sedation. Pediatric patients are more likely to have respiratory complications because of their higher lung resistance. Infants less than seven months are at higher risk due to obligatory nasal breathing. Additionally, children are less resistant against hypoxemia. Respiratory infections in children with known hyperactive airways are an absolute contraindication for elective endoscopy in sedation. In most cases deep sedation or general anesthesia is necessary.

According to the most recent analysis and guidelines, propofol-based sedation seems to be the safest and most convenient method of inducing a sufficient sedation [ 12 ]. In most hospitals an interdisciplinary team of pediatric gastroenterologists, pediatric intensivists or anesthetists and specialized nurses is involved in the endoscopy procedures.

All patients should be monitored regarding the cardiovascular system including oxygen-saturation. Monitoring should be continued for 15 to 30 minutes after the procedure. Afterwards the patient should stay on the ward for at least two hours. Intake of clear fluid is possible one hour after sedation. Discharge is possible if sufficient cardiovascular function and airway patency is confirmed, the patient is fully oriented and protective reflexes are intact [ 13 ].

Basic equipment includes emergency equipment for children of all ages, such as intravenous lines, laryngoscopes, tubes, masks and nasogastric tubes. Endoscopes must be chosen regarding the age of the pediatric patient. Additionally, catheters have to be provided to solve possible complications and make unexpected treatments.

The gastroscopes used in adults can be used in children above 25 kg [ 14 ]. Smaller endoscopes 5 to 8 mm are appropriate for smaller children. Colonoscopes used in adults 11 to 13 mm may be used in adolescents, whereas in very small patients colonoscopies can be performed with slim gastroscopes.

Atlas of Pediatric Gastrointestinal Endoscopy

In these cases colonoscopy has to be performed with extreme precaution as the higher stiffness of gastroscopes may lead to a higher risk of perforation. Additionally, catheters of different calibers depending on the thickness of the endoscope have to be provided. In parallel with the increase in pediatric EGD procedures since the s, the incidence of disorders that require EGD for diagnosis in children has increased. Franciosi et al. There was a fold increase in the number of first-time EGDs performed from to This may lead to an increasing incidence of disease rates. However, an increase of disease rates may instead reflect increasing rates of disease diagnosis rather than a true rise of disease occurrence.

The inclusion of children with less severe clinical presentations and the collection of greater numbers of biopsies per procedure might play an influencing role. EoE is a disorder, which requires EGD with biopsy for diagnosis.

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The sensitivity of detecting EoE is dependent on the number of esophageal biopsies taken at the time of diagnosis. Furthermore, the recognition of EoE as a distinct clinical entity from gastroesophageal reflux disease GERD and functional abdominal pain has increased the use of pediatric EGD in the last decade as an important diagnostic modality for a disorder that can otherwise not be diagnosed.


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Celiac disease is another important pediatric GI disorder in which endoscopy is the gold standard used to establish the diagnosis. A dramatic rise in the incidence rate of celiac disease has been reported from 0. The estimated prevalence of celiac disease in subjects without risk factors is as high as 0. Celiac disease has often been described as an iceberg: subjects with severe symptomatic disease are more likely to go to their physician and have their diagnosis of celiac disease confirmed by duodenal biopsy represent only a small fraction of the true population with milder or even asymptomatic disease.

According to recent guidelines EGD is recommended for all patients suspected of inflammatory bowel disease IBD irrespective of the presence or absence of upper gastrointestinal symptoms [ 18 , 19 ]. In contrast to previous publications, Kugathasan et al. EGD for possible oncologic diseases of the upper GI-tract in children is rare. However, investigation of graft-versus-host-disease GvHD is a common indication for EGD after bone marrow transplantation [ 21 ]. Although most EGDs are performed due to diagnostic indications, there are a few therapeutic procedures, which have also increased during the last decades:.

Foreign bodies. Removal of ingested foreign bodies is urgent if the swallowed objects are found in the esophagus. Additionally, food bolus impaction due to strictures, stenosis or EoE is an indication for urgent removal. Ingested foreign bodies, which have passed the esophagus, will pass the GI-tract in most cases. However, sharp or toxic foreign bodies, for example batteries, have to be removed.

Regardless of the properties of the ingested object EGD is indicated if passing is delayed and foreign bodies remain in the stomach. Additionally, harmless appearing objects might induce tissue-damage. Ingestion of multiple magnets for example, from toys, jewelry may cause intestinal obstruction and perforation, so that immediate retrieval is indicated after ingestion of these objects. Creating awareness is necessary since the number of emergency retrievals of magnets has risen in the last few years.

Most ingested foreign bodies are coins, batteries and toys. Button batteries are the most dangerous parts, because the risk of tissue necrosis in the esophagus is particularly high. Batteries can lead to severe esophageal damage and fistula formation even days after their removal indicating the urgency of foreign body retrieval [ 22 ]. Due to its good outcome, PEG placement has become widely accepted in infants and children needing long-term tube-feeding. However, it has well-recognized complications [ 23 ]. According to recent recommendations, enteral nutrition exceeding four to six weeks is an indication for gastrostomy or enterostomy [ 24 ].

Endoscopic treatment of gastroesophageal reflux disease in children with endoluminal gastroplication can be performed in specialized centers with a good outcome [ 25 ]. Treatment of upper gastrointestinal bleeding caused by portal hypertension includes variceal band ligation and sclerotherapy, which are both safe and effective techniques in children and can be done even in small infants [ 26 ].

Practical Pediatric Gastrointestinal Endoscopy

The safety and effectiveness of colonoscopy in the detection of lower GI-tract pathology in children has been established during the last three decades. Skills and experience have advanced to the point that both diagnostic and therapeutic colonoscopies are now routinely performed by most pediatric gastroenterologists. The available equipment permits examination of all pediatric patients including neonates. Successful completion including ileal intubation is a technical challenge among all pediatric patients. An additional level of complexity in pediatric patients is the poor compliance with the necessary bowel cleansing and the difficulties in sedating a frightened or otherwise uncooperative patient.

In infants, adequate preparation can usually be obtained with the use of small-volume enemas and by substituting clear liquids for milk 12 to 24 hours prior to the procedure. Since there is no ideal bowel cleansing regimen in children, various protocols have been compared by Turner et al.

Several evidence-based protocols were proposed to optimize preparation and minimize adverse effects [ 27 ].

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The safety and effectiveness of large polyethylene glycol-based solutions with electrolytes PEG-ES , causing osmotic diarrhea, has been demonstrated. Nevertheless, taste and volume might be barriers to efficient colonoscopy preparation. Continuous application via a nasogastric tube might improve tolerability in some of the children. Recently, the safety and efficacy of a two-day small volume electrolyte-free preparation PEG-P has been reported, which, additionally, was well tolerated and might improve compliance in the near future [ 30 ].

The indications for diagnostic colonoscopy in children are basically similar to the ones in adults. As shown, the main causes leading to colonoscopy in children are hematochezia, abdominal pain and diarrhea. The most common endoscopic diagnoses are IBD diagnosis or review , juvenile polyps with polypectomy , polyposis syndromes diagnosis or review , allergic colitis and miscellaneous vascular anomaly, infective colitis, tumors or GvHD [ 31 , 32 ].

upper gastrointestinal endoscopy procedure

Absolute contraindications to colonoscopy in pediatric patients are suspected bowel perforation and acute peritonitis. The result is a book that is complete but at the same time easy to read and to understand Very nice book, complete, well written and apporpiately referenced, but at the same time easy to understand. Its nice figures, tables and charts allow a quick and easy interpretation to the readers"- G.

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