General considerations and updates in pediatric gastrointestinal diagnostic endoscopy

Abstract

Gastrointestinal and colonic endoscopic examinations have been performed in pediatric patients in Korea for 3 decades. Endoscopic procedures are complex and may be unsafe if special concerns are not considered. Many things have to be kept in mind before, during, and after the procedure. Gastrointestinal endoscopy is one of the most frequently performed procedure in children nowadays, Since the dimension size of the endoscopy was modified for pediatric patients 15 years ago, endoscopic procedures are almost performed routinely in pediatric gastrointestinal patients. The smaller size of the scope let the physicians approach the diagnostic and therapeutic endoscopic procedures. But this is an invasive procedure, so the procedure itself may provoke an emergence state. The procedure-related complications can more easily occur in pediatric patients. Sedation-related or procedure-related respiratory, cardiovascular complications are mostly important and critical in the care. The endoscopists are required to consider diverse aspects of the procedure - patient preparation, indications and contraindications, infection controls, sedation methods, sedative medicines and the side effects of each medicine, monitoring during and after the procedure, and complications related with the procedure and medicines - to perform the procedure successfully and safely. This article presents some important guidelines and recommendations for gastrointestinal endoscopy through literature review.

Use of Hypnosis in Paediatric Gastrointestinal Endoscopy: A Pilot Study

“…The presence of parents during EGD was associated with successful endoscopy. In addition to a preparation session when clear information is given to parents and their child, parental presence is known to participate in the relief from child pre-operative stress ( 25 ). In a study including 42 adults who underwent EGD, alone or accompanied, it was shown that patients with a guide tended to have lower anxiety than those without, with a higher benefit when the patients had a higher level of anxiety before the procedure ( 26 ).…”

Eesophagogastroduodenoscopy in paediatrics: does abiding by the international guidelines lead to appropriate management? A cross-sectional study

“… 3 Though EGD in children is relatively safe, it still has a small but definite risk. 6 7 Therefore, the appropriateness of endoscopy in children is an important subject. Several guidelines for the ‘appropriateness’ and ‘inappropriateness’ of EGD in paediatrics have been established by the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), The European Society for Gastrointestinal Endoscopy (ESGE) and the North American Society of Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).…”

“…The number of performed endoscopies in units in developing countries is on the rise, and the leading concern is that EGD is overused even in paediatrics 3. Though EGD in children is relatively safe, it still has a small but definite risk 6 7. Therefore, the appropriateness of endoscopy in children is an important subject.…”

Diagnostic Yield of Upper Gastrointestinal Endoscopy in Children: A Three Years Experience

“…2,3 Over the past 30 years, paediatric gastroenterology has emerged as a subspecialty in many countries and increased practice has led to issuing guidelines by the NASPGHAN, ESPGHAN in 1999 for trainees to ensure competence in the field of paediatric gastroenterology and training paediatric endoscopy. [3][4][5][6] A 12 -fold increase in the rate of upper endoscopic procedures from 7.9% to 95.2% procedures per 100,000 children per year between 1985 -2005 has been reported by Franciosi et al 2 However, in developing countries, this diagnostic modality is still being under-utilised which can be attributed to factors such as lack of knowledge regarding its utility in paediatric population, insufficient competent manpower and resources such as paediatric friendly scopes and suites, and associated exorbitant costs.…”