INTRODUCTION TO PEDIATRIC GASTROINTESTINAL ENDOSCOPY:
Correspondence to: Dr.Yogesh Waikar, Department of Pediatric Gastroenterology &Hepatology,pedgihep@yahoo.com
Dr.Yogesh Waikar
MD, DNB, Fellow in Pediatric Gastroenterology & Liver Transplant.
Consultant Pediatric Gastroenterologist & Endoscopist.
PGHN{pediatric gastroenterology hepatology, nutrition}
- Limited expertise of gastroenterologists in internal medicine regarding unique pediatric aspects.
- pediatricians left pediatrics to train in adult gastroenterology : 1970.
- 2-3% of adult gastroenterology exposure course for pediatric aspects.
| Indications for pediatric upper endoscopy Diagnostic | Indications for pediatric colonoscopy: |
| Dysphagia | Diagnostic |
| Odynophagia | Diarrhea (chronic, clinically significant with weight loss, |
| Intractable or chronic GERD (including surveillance for | fevers, anemia) |
| Barrett’s esophagus) | Hematochezia/melena |
| Vomiting/hematemesis | Anemia (unexplained) |
| Abdominal pain with significant morbidity or signs of | Abdominal pain (clinically significant) |
| organic disease (weight loss, anemia, vomiting, fevers) | Polyposis syndrome (diagnosis and surveillance) |
| Anorexia | Rejection of intestinal transplant |
| Weight loss/failure to thrive | Lower–GI-tract lesions seen on imaging studies? |
| Anemia (unexplained) | Failure to thrive/weight loss |
| Diarrhea/malabsorption (chronic) | Therapeutic |
| Hematochezia | Polypectomy |
| Caustic ingestion | Foreign-body removal |
| Therapeutic | Dilation of strictures |
| Foreign-body removal | Lower-GI bleeding control |
| Dilation of esophageal and upper-GI strictures | |
| Esophageal varices eradication | |
| Upper-GI bleeding control | |
| Endoscopic grading of caustic injury severity | |
| Grade 1(superficial) | |
| Edema and hyperemia of mucosa | |
| Grade 2a(transmucosal) | |
| Hemorrhage; exudate, erosions | |
| and blisters, superficial ulcers | |
GUIDELINES SUMMARY ON PEDIATRIC ENDOSCOPY:
- Endoscopic procedures including ERCP, EUS, WCE, and DBE in the pediatric population are both safe and effective
- Endoscopy in children should be performed by pediatric- trained gastroenterologists whenever possible.
- Endoscopy should be performed in symptomatic pediatricpatients with known or suspected ingestion of causticsubstances and should be considered even in theabsence of symptoms.
- Procedural and resuscitative equipment of a size and type appropriate for pediatric use should be readily available during endoscopic procedures.
- Preprocedural preparation should be individualized according to the patient’s age, size, clinical state, andplanned procedure.
- Preprocedural fasting from milk and solids vary by institutionalrequirements but a minimum fasting from alloral intake (including clear liquids) of 2 hours is recommended.
- The presence of personnel trained specifically in pediatric life support and airway management during procedures requiring sedation is strongly recommended.
- The majority of patients can be sedated adequately forupper endoscopy and colonoscopy with a combination of an opioid and benzodiazepine
- Transmission of infection as a result of GI endoscopes is extremely rare.
- The first and most important step in the prevention of transmission of infection by an endoscopy is manual cleaning of the endoscope with detergent solution and brushes.
- Manufacturers’ recommendations should be adhered to for each type of endoscope.
- HLD –HIGH LEVEL DISINFECTANT destroys vegetative microorganisms, mycobacteria, fungi, small or nonlipid viruses, medium or lipid viruses, but not necessarily large numbers of bacterial spores.
- Sterilization can be achieved by using a variety of methods, including ethylen oxide gas treatment, and may also be achieved with appropriately long exposure to LCGs-LIQUID CHEMICAL GRAIDENTS.
REFERENCES:
- GASTROINTESTINAL ENDOSCOPY Volume 67, No. 1 : 2008 Modifications in endoscopic practice for pediatric patients,GUIDELINES.
- GASTROINTESTINAL ENDOSCOPY Volume 68, No. 2 : 2008, Sedation and anesthesia in GI endoscopy
- GASTROINTESTINAL ENDOSCOPY Volume 67, No. 6 : 2008 Infection control during GI endoscopy