GeorgeGershmanMarvinAmentPractical Pediatric Gastrointestinal Endoscopy2006Blackwell PublishingMalden, Massachusetts216 pp. $175.00. ISBN 1-4051-3193-4. Web site for ordering: www.blackwellpublishing.com

Abstract

Despite the many comparisons that can be made between performing gastrointestinal endoscopy in children versus adults, the old maxim still applies: Children are not little adults, and pediatric endoscopy is its own specialized procedure. Practical Pediatric Gastrointestinal Endoscopy is a succinct, comprehensive guide to performing diagnostic and therapeutic upper and lower gastrointestinal procedures in newborns, toddlers, older children, and adolescents. As a textbook, it is particularly ideal as an introduction to endoscopy for trainees in pediatric gastroenterology; it tackles topics of concern to that specialty. For example, there may be differences not only in medication regimens used to prepare for colonoscopy, but also in approaches used to explain the need to do so in young children versus adolescents. Ultimately, this book may also prove to be a worthy reference to keep on the shelf for those adult gastroenterologists who are occasionally asked to help care for children with gastrointestinal disease. Although most endoscopic views of the mucosa are the same in adults and children, there are a multitude of notable differences that are discussed in each of the 10 chapters. For example, scattered whitish spots in the second and third part of the duodenum consistent with dilated lacteals are often seen in children and are of unclear diagnostic importance. Similarly, multiple lymphoid follicles are common on rectal mucosa and in the terminal ileum, especially in infants and toddlers, and are rarely significant. It is equally important to recognize procedural differences. For example, children have significantly shorter lengths of sigmoid colon than adults, and accordingly, less elasticity for tolerating looping during colonoscopy. Creating and reducing “alpha loops” to maneuver the sigmoid-descending junction is often not possible in children, who by nature are not cooperative with undergoing procedures. The combination of increased stretch with looping and less tolerance of discomfort can make performing colonoscopy in sedated children a remarkably tricky venture. Several well-respected opinion leaders in the field of pediatric endoscopy are credited with contributing to this hardcover, 199-page book, which is authored by Drs George Gershman and Marvin Ament from the University of California, Los Angeles. The primary authors relate often to their own institutional protocols; they end each chapter with a bibliography of suggested pertinent readings. The book is well indexed and the Table of Contents provides a valuable outline with page numbers detailing the location of topic sections in each chapter, adding to its usefulness as a reference text. In a one-page introduction, the authors define endoscopy as an invasive procedure with potential morbidity that can be minimized if proceduralists are comfortable and familiar with technical aspects of their equipment, medication doses, and proper techniques. They also explain that pediatric endoscopists must take an age-related view of anatomic variations of the gastrointestinal tract, as well as the range of physiologic, psychological, and behavioral responses their patients are likely to have to the procedure itself. At 37 pages, Chapter 3 is the longest chapter in the book and is devoted to in-depth dissection of the technology and mechanical design underlying today’s video endoscopes. Throughout Chapter 3, there are multiple understandable cross-sectional and end-view schematics that clearly explain many of the intricate technical concepts underlying construction of endoscope insertion tubes, illumination, and video image capture described in the text. The remainder of the book is generally devoted to procedural techniques involved in diagnostic and therapeutic pediatric endoscopy and colonoscopy. Although most chapters are generously illustrated with color photography and luminal images of anatomic landmarks and pathology, there are few other diagrams accompanying the in-depth passages describing endoscopic maneuvers. In a second edition, one would hope to see increased use of technical drawings to clarify the detailed descriptions and useful tips for performing endoscopy in children. Bottom Line: This is an excellent, concise, introductory endoscopy reader for novices in pediatric endoscopy. It is well written and easy to read from cover to cover. It can also function as a reference text owing to its detailed organization and index.