Is Gastroscope Better Than Colonoscope in Pediatric Colonoscopy?

Abstract

Background: Colonoscopy may be unsuccessful in some children because of fixed or tight sigmoid loop or stenosis. In addition perforation is a concern in younger children. An alternative for the younger children is to use a gastroscope. There have been a few published studies in adults on the success of gastroscope for incomplete colonoscopy, but there is no published data in children. Aim: To demonstrate the use of gastroscope for colonoscopy in children weighing ≤ 30 kg. We defined a successful colonoscopy as cecal intubation. Subjects: We used the gastroscope in 17 children, age 3-12 yrs (mean 7), weight 13-30 kg (mean 22). Also one older patient (15 yrs, 50 kg) in whom colonoscope was changed to gastroscope because of a difficult loop in the left colon was included. Indications for colonoscopy: abdominal pain (7), rectal bleeding (3), diarrhea (4), or combinations of the above and short stature. We used the pediatric colonoscope in 18 controls, age 2-8 yrs (mean 5), weight 12-28 kg (mean 20) with similar indications. Methods: Description of the two scopes that we used is: Pediatric Colonoscope (Pentax EC 3430LK)∗11.8 mm outer diameter∗3.8 mm channel diameter∗170 cm working length∗Angulations 180/180 up/down, 160/160 right/leftGastroscope (Pentax EG 2730LK)∗9.0 mm outer diameter∗2.8 mm channel diameter∗103 cm working length∗Angulations 210/120 up/down, 120/120 right/leftTechnique: Both groups were prepared for colonoscopy with a clear liquid diet, magnesium citrate and bisacodyl. Sedation was given via propofol. We retrospectively compared the two groups for cecal intubation rate, ileal intubation rate, complications, and ease of the procedure as judged by the endoscopists. Results: Cecal intubation rate was 100% in both groups. Ileal intubation was done in 14 patients with gastroscope and 8 patients with colonoscope (p = 0.09). Endoscopic findings were similar in both groups: colitis (6), polyps (4), anal fissures (2), and normal (24). Polypectomy was done with gastroscope (1) and colonoscope (3). Retroflex view was easier with the gastroscope (as it made a 210 turn) than the colonoscope. Both groups had no complications like perforation, undue bleeding or pain requiring hospitalization. The endoscopists judged the procedures as easier to perform with the gastroscope. Conclusion: The gastroscope is a safe and effective tool for perfoming colonoscopy in children ≤ 30 kg. There was a higher, though not statistically significant rate of ileal intubation in the gastroscope group. The ease of colonoscopy was assessed as superior using the gastroscope. Larger prospective studies are needed to corroborate these findings.