Equipment for pediatric endoscopy

Barth, Bradley; Banerjee, Subhas; Bhat, Yasser M.; Desilets, David J.; Gottlieb, Klaus; Maple, John T.; Pfau, Patrick R.; Pleskow, Douglas K.; Siddiqui, Uzma D.; Tokar, Jeffrey L.; Wang, Amy; Song, Louis M. Wong Kee; Rodriguez, Sarah A.

doi:10.1016/j.gie.2012.02.023

Cited by 86 publications

(63 citation statements)

References 109 publications

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“…The safety of pediatric colonoscopy has been established, although the immediate complication rate of pediatric colonoscopy has been reported to be 1.1%, which is higher than that in adults (0.3%) [14], [15]. Our study showed no serious complications during the procedure, such as bleeding and perforation.…”

Section: Discussionmentioning

confidence: 41%

Pediatric Colonoscopy in South China: A 12-Year Experience in a Tertiary Center

Lei

Hong

et al. 2014

PLoS ONE

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ObjectiveTo investigate: 1) the demographics and clinical characteristics, 2) the findings, and 3) the safety and effectiveness in a cohort of Chinese pediatric patients undergoing colonoscopy.MethodsThe study participants were consecutive patients aged ≤14 years old that underwent their first colonoscopy in the endoscopy center at the First Affiliated Hospital, Sun Yat-sen University between Jan. 1, 2001 and Dec. 31, 2012. Demographic, clinical, endoscopic, and pathological findings were collected.ResultsThe cohort consisted of 322 patients, including 218 boys (67.7%) and 104 girls (32.3%). The median age was 8.0 years old and ranged from 9 months to 14 years old. Hematochezia (48.8%) and abdominal pain/discomfort (41.3%) were the most common presentations preceding pediatric colonoscopy. The caecal intubation success rate was 96.3%. No serious complications occurred during the procedures. A total of 227 patients (70.5%) received a positive diagnosis under endoscopy, including 138 patients with polyps and 53 patients with inflammatory bowel disease (IBD). Among the patients with polyps, 71.0% were juvenile polyps. Comparisons between years 2001–2006 and 2007–2012 showed that the IBD detection rate increased significantly (4.6% vs. 22.4%, P<0.001), while the opposite occurred for the polyp detection rate (73.1% vs. 27.6%, P<0.001).ConclusionColonoscopy in pediatric patients is a safe and effective procedure. Polyps are the primary finding during colonoscopy. In South China there has been an increase in pediatric patients diagnosed with IBD over the past decade. However, a large epidemiological study is needed to confirm our findings.

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Section: Discussionmentioning

confidence: 41%

Pediatric Colonoscopy in South China: A 12-Year Experience in a Tertiary Center

Lei

Hong

et al. 2014

PLoS ONE

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“…We used a small diameter pediatric duodenoscope (PJF160) for children <12.5 kg which is in accordance with current ASGE recommendations. 20 This duodenoscope is available for immediate use in our center but can also be obtained for loan on a case-by-case basis. The small working channel makes therapeutic ERCP more challenging as only specialized equipment and small caliber stents (up to 5Fr) are accepted.…”

Section: Discussionmentioning

confidence: 99%

ERCP in infants, children and adolescents is feasible and safe – results from a tertiary care center

et al. 2016

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Background: Indications for endoscopic retrograde cholangiopancreatography (ERCP) in children differ from adults. Paucity of data and concerns about potential lower effectiveness and more side effects limit its use even in high volume centers. We retrospectively analyzed indications, success rates, limitations, and side effects of ERCPs in children <18 years. Methods: From January 2012 to March 2015, 54 ERCPs were performed in 31 children (median age 11 (0-17) years; median weight 22 (3.3-142.7) kg) with suspected choledocholithiasis (n ¼ 13 interventions in 9 patients), post-transplantation anastomotic stenosis (10/4), malignancy (10/5), chronic pancreatitis (7/1), biliary atresia (6/6), anomaly (2/2), leak (4/3), or primary sclerosing cholangitis (PSC) (2/1). All patients were followed up as inpatients. Results: Thirty-six therapeutic and 18 diagnostic procedures were performed by adult ERCP expert endoscopists. Successful intervention was achieved in 90.7% of cases. Failed cannulation (n ¼ 4) was associated with lower body weight (p ¼ 0.023). In children younger than 1 year, ERCP was significantly more often diagnostic than in patients >1 year (p < 0.001). In three of six infants with suspected atresia, surgical exploration was avoided. Five complications were recorded (9.3%), and included four episodes of mild pancreatitis (7.4% post-ERCP pancreatitis (PEP) rate) and one cholangitis in PSC. A trend towards a protective effect of pancreatic stents on PEP was observed. All complications were managed conservatively. No complications were attributed to mechanical stress on the gastrointestinal tract. Conclusions: ERCP in newborns, infants, and adolescents can be safely performed with high technical and clinical success. Endoscopists must be aware of differing spectrum of pediatric diseases. Failed cannulation was associated with lower body weight of young children. Complications were similar to rates reported in adults.

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“…Use of the larger echoendoscopes should be limited to pediatric patients weighing at least 15 kg, and caution should be used, given their relatively rigid distal tip.” In patients weighing <15 kg it has been suggested that “through-the scope miniprobes with frequencies ranging from 12 to 30 MHz may be used through standard gastroscopes with a 2.8-mm working channel.”[7]…”

Section: Discussionmentioning

confidence: 99%

Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population

et al. 2017

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Background and Objectives:The safety and utility of endoscopic ultrasound (EUS) for the evaluation and management of gastrointestinal (GI) tract disorders among adults has been established. The literature on safety and efficacy in a pediatric referral population (under 21 years of age) is limited. We hypothesized that EUS is safe and useful in the pediatric population. We reviewed the pediatric EUS experience at a single tertiary-care system. We describe the indications, findings, safety, technical success rate, and impact on clinical outcomes.Patients and Methods:All patients 21 years of age or younger referred for EUS between 5, 2007 and 11, 2012 were identified from our electronic medical record databases. Retrospective chart review was then conducted to document demographics, procedure indications, procedure type (diagnostic or therapeutic), type of anesthesia used, EUS findings, and the clinical impact of EUS on the subsequent management of the patients.Results:Seventy EUS procedures were attempted in 58 patients during the study. Of these, two EUS procedures were aborted due to inadequate moderate sedation and 68 were successfully completed. The median age at initial endoscopy was 18 years (range 6–21 years), 50% were male and 65% were Caucasian. Four patients underwent EUS-guided pseudocyst drainage. Among the remaining 54 patients, the indications for EUS were the evaluation of GI mucosal/submucosal lesions (n = 14), acute or recurrent pancreatitis (n = 10), localization of suspected insulinoma (n = 8), evaluation of pancreatic abnormalities seen on prior imaging (n = 6), surveillance of tumors or evaluation of luminal lesions in hereditary syndromes (n = 6), abdominal pain of suspected pancreatobiliary origin (n = 5), and other rare indications (n = 5). Fine-needle aspiration was performed in 13 (9 diagnostic, 4 therapeutic) and trans-gastric fine-needle contrast injection of the pancreatic duct was performed in one patient without any complications. Sedation (data available for 66 procedures) included general endotracheal anesthesia in 38 (57%), monitored anesthesia care (MAC) in 19 (29%), and moderate sedation in 9 (14%). There were 4 minor intra-procedural anesthesia-related complications (laryngospasm in 2 and hypoxemia from airway obstruction and secretions in 2) in MAC and general endotracheal anesthesia (GA) cases, and 1 postprocedural complication (fever after pseudocyst drainage). EUS can achieve the diagnostic or therapeutic goal and ruled out suspected pathology in 88% of cases precluding need for additional testing.Conclusions:(1) EUS in the pediatric population is technically successful and efficacious. (2) Therapeutic and diagnostic EUS impacted clinical care decisions. (3) There is a low risk of immediate significant complications. (4) The overall efficacy and safety support the performance of EUS in a pediatric population by experienced endoscopists.

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Equipment for pediatric endoscopy

Cited by 86 publications

References 109 publications

Pediatric Colonoscopy in South China: A 12-Year Experience in a Tertiary Center

Pediatric Colonoscopy in South China: A 12-Year Experience in a Tertiary Center

ERCP in infants, children and adolescents is feasible and safe – results from a tertiary care center

Endoscopic ultrasound with or without fine-needle aspiration has a meaningful impact on clinical care in the pediatric population

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