Endoscopy In Children Research Articles

Safety Analysis of Upper Gastrointestinal Tract Endoscopy in Children and Adolescents After Allogeneic Hematopoietic Stem Cell Transplantation: A Five-Year, Single-Institution Survey

Safety Analysis of Upper Gastrointestinal Tract Endoscopy in Children and Adolescents After Allogeneic Hematopoietic Stem Cell Transplantation: A Five-Year, Single-Institution Survey

Adenoid Assessment in Paediatric Patients: The Role of Flexible Nasal Endoscopy

Adenoid hypertrophy is the most common cause of nasal obstruction in paediatric patients. Over the years, various methods to assess the adenoid size were proposed such as the posterior rhinoscopy and the radiological examination of the nasopharynx. Nasal endoscopy was introduced for children in the 80's, and nowadays this is a known and diffuse method in routine practice. The purpose of this article is to describe the personal experience in the assessment of the adenoid size in children, with a particular regard to the flexible nasal endoscopy, and to analyse the literature reports. The personal technique is described in performing nasal endoscopy in paediatric patients, reporting advantages and possible disadvantages of the procedure. A retrospective analysis was conducted on 6036 children since 1999 to 2010. In most cases children fully collaborated to complete the exam. No major or minor complications (such as nose bleedings or other traumatic injuries) were observed. No topical intranasal decongestant, local or general anaesthesia were used in our series. In our opinion, nasal endoscopy in children is a reliable, safe, accurate, easily tolerated and dynamic diagnostic method to assess the adenoid size.

Nasal endoscopy in children with suspected allergic rhinitis

Ear, nose, and throat assessment may be frequently requested for children with allergic rhinitis (AR). Nasal endoscopy allows a thorough evaluation of the nose. The aim of the study was to investigate whether there are endoscopic signs predictive for AR diagnosis in a cohort of children with suspected AR. Cohort of observational study. There were 176 children (99 males; mean age, 7.5 years) studied. Clinical visit, nasal endoscopy, and skin prick test were performed in all patients. Nasal endoscopic signs were pale turbinates, middle turbinate contact, and inferior turbinate contact. The AR diagnosis was made when nasal symptom history was concordant with sensitization. AR was diagnosed in 141 children. Inferior and middle turbinate contact were reliable predictive factors for AR (odds ratio 5.38 and 3.42, respectively), whereas pale turbinates did not predict it. This study suggests that nasal endoscopy may reveal signs predictive for AR diagnosis in children.

Intradural spinal endoscopy in children

Intracranial endoscopy in the treatment of hydrocephalus, arachnoid cysts, or brain tumors has gained wide acceptance, but the use of endoscopy for intradural navigation in the pediatric spine has received much less attention. The aim of the authors' present study was to analyze their experience in using spinal endoscopy to treat various pathologies of the spinal canal. The authors performed a retrospective review of intradural spinal endoscopic cases at their institution. They describe 4 representative cases, including an arachnoid cyst, intrinsic spinal cord tumor, holocord syrinx, and split cord malformation. Intradural spinal endoscopy was useful in treating the aforementioned lesions. It resulted in a more limited laminectomy and myelotomy, and it assisted in identifying a residual spinal cord tumor. It was also useful in the fenestration of a multilevel arachnoid cyst and in confirming communication of fluid spaces in the setting of a complex holocord syrinx. Endoscopy aided in the visualization of the spinal cord to ensure the absence of tethering in the case of a long-length Type II split spinal cord malformation. Conclusions Based on their experience, the authors found intradural endoscopy to be a useful surgical adjunct and one that helped to decrease morbidity through reduced laminectomy and myelotomy. With advances in technology, the authors believe that intradural endoscopy will begin to be used by more neurosurgeons for treating diseases of this anatomical region.

Video glasses in endoscopy in children – a preliminary report

The endoscopy is nowadays the basic diagnostic method in otolaryngology. However, the size and distance of the video display and the location of the monitor continue to be impediments to endoscopy due to the inadequate alignment of the optical axis. In this study, I evaluate the practical usefulness of video glasses in endoscopy. The video glasses, weighing 115 g, which are designed for consumer video home use, consisting of two active LCD color panels with over 300000-pixel resolution. The operator sees the image in front of them, and below the glasses, simply by moving his or her eyes, thus seeing the patient and the field of intervention. 76 patients participated in this study; all of having undergone nasal endoscopy and flexible nasopharyngoscopy. The video glasses allowed me to use an ultra large screen as if there was a 115-cm screen 2 m in front of me. During endoscopy, I could concentrate more on the procedures. There were no complications attributable to the use of the device. In my opinion the video glasses may represent a viable alternative to conventional displays for endoscopy, but definition of the specific roles requires further investigation.

Sa1604 The Value of Integrated Pulmonary Index (IPI) Monitoring During Endoscopies in Children

Sa1604 The Value of Integrated Pulmonary Index (IPI) Monitoring During Endoscopies in Children

The Prognostic Value of Obtaining a Negative Endoscopy in Children With Functional Gastrointestinal Disorders

Functional gastrointestinal disorders (FGIDs) are common. Diagnosis is based on the Rome criteria. It has been argued that performing endoscopies could help by providing reassurance and thus improve outcomes. This study was conducted to evaluate the impact of obtaining normal endoscopies in the outcome of children with FGIDs. Medical records of patients diagnosed with abdominal pain related-FGIDs were reviewed. To assess the child's symptoms at follow-up, parents completed the Questionnaire on Pediatric Gastrointestinal Symptoms III (QPGS III). Primary outcome was presence of abdominal pain (AP) and secondary outcomes were AP severity. A total of 301 patients were diagnosed with abdominal pain-related FGIDs. Overall, 62.6% reported persistence of AP and 37.4% were asymptomatic at follow-up. Among patients with endoscopies, 61% reported AP. Among patients without endoscopies, 64% were symptomatic (P = .76). AP frequency, AP intensity, and child's disability were similar in those with and without endoscopies. The study does not suggest that a negative endoscopy improves the outcome of children with FGIDs.

Comparison between symptoms and endoscopy in children with nasal obstruction

Objective Nasal obstruction is a common symptom in childhood. It may be frequently observed in children with allergic rhinitis and/or adenoidal hypertrophy. However, its assessment is very difficult. The aim of the study was to compare the use of both a Face Related Scale (FRS), recorded by children and their parents, and a simplified Visual Analogue Scales (sVAS) with nasal endoscopy in children complaining nasal obstruction. Methods 121 children (75 males, mean age 7.5 years) were studied. FRS and sVAS for nasal obstruction and endoscopy were performed in all patients. Results A moderate correlation has been observed between FRS and sVAS and obstruction of nasal anterior segment ( r = 0.51 for FRS; r = 0.52 for sVAS), a strong correlation was observed with nasal posterior segment ( r = 0.60 for FRS; r = 0.61 for sVAS) assessed by endoscopy. However, parents’ perception did not relate with objective parameters. Conclusions This study suggests that assessment of FRS and sVAS for nasal obstruction may be used in clinical practice to approximately quantify this symptom in children.

Changing Indications for Upper Endoscopy in Children During a 20‐year Period

In parallel with the increase in pediatric esophagogastroduodenoscopy (EGD) procedures since the 1970s, the incidence of disorders that require EGD for diagnosis in children has increased. The aim of this study was to identify changes in subject characteristics and endoscopic procedures during a 20-year interval in children undergoing EGD at a single center. All of the children undergoing first EGD with biopsy in 1985, 1995, or 2005 were identified. Details of the clinical presentation and EGD were abstracted from medical records in a random sample of subjects within each time point. The number of first-time EGDs rose dramatically from 107 in 1985 to 1294 in 2005. The proportion of subjects that were younger than 1 year of age varied significantly from 13% in 1985 to 23% in 1995 and 8% in 2005 (P < 0.001). The proportion of subjects with gastrointestinal (GI) bleeding declined from 34% to 5% during the 20-year interval (P < 0.001), whereas the proportion with abdominal pain increased from 23% to 43% (P < 0.01). During the same interval, the proportion of subjects with complete EGD (biopsies from the esophagus, stomach, and duodenum) increased from 18% of EGDs in 1985 to 95% in 2005 (P < 0.001). This study of children undergoing first-time EGDs with biopsy during a 20-year interval demonstrated significant differences in subject characteristics and endoscopy practices. The inclusion of children with less severe clinical presentation and the collection of greater numbers of biopsies per procedure may contribute to the rising incidence rates of pediatric GI disorders.

Prognostic Value of Endoscopy in Children With Biliary Atresia at Risk for Early Development of Varices and Bleeding

Biliary atresia is the most common cause of childhood cirrhosis. We investigated prospectively the development of portal hypertension in 139 children with biliary atresia, the risk of gastrointestinal (GI) bleeding in the first years of life, and associations between endoscopic patterns of varices and risk. Children with clinical or ultrasonographic signs of portal hypertension underwent upper GI endoscopy examinations (n = 125, median age of 13 months). Information was recorded about esophageal varices and grade, red wale markings on the variceal wall, gastric varices along the cardia, and portal hypertensive gastropathy. A second endoscopy examination was performed in 64 children after a mean interval of 51 months to study their progression or regression. At the first endoscopy examination, 88 of 125 children had esophageal varices, including 74 who were younger than 2 years. Grade II and III varices, red markings, gastric varices, and signs of gastropathy were present in 29, 30, 24, and 27 children, respectively. At the second endoscopy examination, progression, stability, and regression of endoscopic signs were observed in 37, 18, and 9 of the 64 children, respectively. Twenty-eight children had GI bleeding at a median age of 17 months. Multivariate analysis showed that red markings, and most importantly gastric varices, were independent factors associated with bleeding. Children with biliary atresia have a high risk of portal hypertension in the first years of life. Spontaneous regression of varices is rare. Children with a combination of esophageal varices and red markings and/or gastric varices along the cardia should receive primary prophylaxis of bleeding.

Impact of the Rome II paediatric criteria on the appropriateness of the upper and lower gastrointestinal endoscopy in children

The demand for paediatric gastrointestinal (GI) endoscopy has increased, resulting in a significant rise of overall costs. To assess the clinical impact of the Rome II criteria for functional gastrointestinal disorders when selecting paediatric patients who underwent GI endoscopy. The indications and findings of GI endoscopic procedures performed before and after the publication of the Rome II criteria were evaluated retrospectively. Upper GI endoscopy was performed in 1124 children, whereas colonoscopy was performed in 500 subjects. A total of 607 (54%) oesophago-gastro-duodenoscopies (OGDs) were positive and 517 (46%) were negative, whereas 306 (61.1%) colonoscopies were positive and 194 (38.9%) were negative. Of the 1624 procedures, 26% were considered inappropriate according to the Rome II criteria. Inappropriate procedures decreased significantly after publication of the Rome II criteria (OR, 3.7; 95% CI, 1.8-7.5). Of 1202 appropriate GI endoscopies, 502 OGD (62.7%) were significantly contributive, compared with only 105 (32.5%) of the 323 inappropriate procedures (OR, 3.5; 95% CI, 2.6-4.6), whereas 265 (65.8%) colonoscopies were significantly contributive, compared with only 41 (42.3%) of the 97 inappropriate procedures (OR, 2.6; 95% CI, 1.6-4.1). The use of the criteria for functional gastrointestinal disorders makes a significant positive impact, they should reduce unnecessary paediatric GI endoscopy.

Indications to Upper Gastrointestinal Endoscopy in Children With Dyspepsia

The objective of the study was to ascertain the appropriateness of indications for upper gastrointestinal (UGI) endoscopy in children with dyspepsia. We used the RAND/University of California at Los Angeles method to investigate the appropriateness of the opinions of a panel of experts. The panel judged 2304 theoretical patient scenarios defined by a combination of demographic and clinical variables. Descriptive and multivariate logistic regression analyses were performed. The panel rated UGI endoscopy as appropriate in 27.2% of cases, inappropriate in 14.3%, and dubious in 58.5%. Disagreement emerged for 21% of cases. UGI endoscopy was considered increasingly appropriate in cases with a positive family history of peptic ulcer and/or Helicobacter pylori infection (odds ratio [OR] 8.518, P < 0.0001), when dyspepsia interfered with activities of daily living ("sleep" OR 7.540, P < 0.0001; "normal activities" OR 5.725, P < 0.0001), and when patients were older than 10 years ("<or=10 years" OR 0.310, P < 0.0001) the longer the duration ("0-2 months" OR 0.002, P < 0.0001; "3-5 months" OR 0.059, P < 0.0001; "6-11 months" OR 0.516, P = 0.0005) and the greater the severity ("mild" OR 0.002, P < 0.0001; "moderate" OR 0.013, P < 0.0001) of their dyspeptic symptoms. UGI endoscopy is not appropriate for all children with dyspeptic symptoms, but only for cases with a family history of peptic ulcer and/or Helicobacter pylori infection, older than 10 years of age, with symptoms persisting for more than 6 months and severe enough to affect activities of daily living.

Total intravenous anesthesia and spontaneous respiration for airway endoscopy in children – a prospective evaluation

Inhalational anesthesia with spontaneous respiration is traditionally used to facilitate airway endoscopy in children. The potential difficulties in maintaining adequate depth of anesthesia using inhalational anesthesia and the anesthetic pollution of the surgical environment are significant disadvantages of this technique. We report our institutional experience using total intravenous anesthesia (TIVA) and spontaneous respiration. We prospectively studied 41 pediatric patients undergoing 52 airway endoscopies and airway surgeries. Following induction of anesthesia, a propofol infusion was titrated to a clinically adequate level of anesthesia, guided by the Bispectral Index (BIS), and a remifentanil infusion was titrated to respiratory rate. ECG, BP, pulse oximetry, BIS level, transcutaneous CO(2) (TcCO(2)), respiratory rate, and drug infusion rates were recorded. Adverse events and the response to these events were also recorded. Forty-one children underwent 52 airway procedures; 17 rigid bronchoscopies and 35 micro-laryngobronchoscopies, including 18 LASER treatments, were performed. The mean (sd) age was 6.9 (5.8) years and weight 26.9 (21.2) kg. The mean induction time was 13 (6) min, and anesthesia duration was 49 (30) min. The mean highest TcCO(2) recorded during the procedures was 62.8 +/- 15.3 mmHg. Coughing occurred in 14 (27%) patients, requiring additional topical anesthesia (3), a bolus of propofol (4) or remifentanil (1), or removal of the bronchoscope (1). Desaturation below 90% occurred in 10 (19%) cases; only three required intervention in the form of temporary assisted ventilation (2) or inhaled bronchodilators (1). No laryngospasm, stridor, or arrhythmias were observed. TIVA and spontaneous respiration is an effective technique to manage anesthesia for airway endoscopy and surgery in children.

A retrospective study of pediatric endoscopy as performed in an adult endoscopy unit

Gastrointestinal endoscopy is a safe, efficient technique with minimal complications, and a useful diagnostic tool for the pediatric population. Under ideal conditions endoscopies for children should be performed by experienced pediatric endoscopists. In this study we report our experience with pediatric endoscopy at the general adult endoscopy unit in our hospital. Our goal is to quantify the number of endoscopies performed in children, as well as their indications and findings, the type of sedation or anesthesia used, and the time waiting for the test to occur. Our experience demonstrates that endoscopists in a general adult gastroenterology department, working together with pediatricians, may perform a relevant number of endoscopies in children in a fast, safe, effective manner.

Capsule Endoscopy in Children

The small bowel is the most difficult intestinal segment to examine. Radiologic tests are mostly insensitive and double-balloon enteroscopy is unsuitable for the younger child. Capsule endoscopy is a novel wireless method of investigation of the small bowel. The primary indications for capsule endoscopy include evaluation of obscure gastrointestinal bleeding, small bowel Crohn's disease, and polyposis syndromes. Capsule endoscopy offers an accurate and effective means of investigating the small bowel in children. Capsule retention is a potential complication of capsule endoscopy. This review provides the indications, safety, and limitations of wireless capsule endoscopy in children. (Korean J Pediatr Gastroenterol Nutr 2010; 13: 1∼6)

Anesthesia and sedation in pediatric gastrointestinal endoscopic procedures: A review.

Gastrointestinal (GI) endoscopic procedure has become an essential modality for evaluation and treatment of GI diseases. Intravenous (IV) sedation and General Anesthesia (GA) have both been employed to minimize discomfort and provide amnesia. Both these procedures require, at the very least, monitoring of the level of consciousness, pulmonary ventilation, oxygenation and hemodynamics. Although GI endoscopy is considered safe, the procedure has a potential for complications. Increased awareness of the complications associated with sedation during GI endoscopy in children, and involving the anesthesiologists in caring for these children, may be optimal for safety. Belonging to a younger age group, having a higher ASA class and undergoing IV sedation were identified as risk factors for developing complications. Reported adverse events included inadequate sedation, low oxygen saturation, airway obstruction, apnea needing bag mask ventilation, excitement and agitation, hemorrhage and perforation. A complication rate of 1.2% was associated with procedures performed under GA, as compared to 3.7% of complications associated with IV sedation. IV sedation was seen to be independently associated with a cardiopulmonary complication rate 5.3% times higher when compared to GA. GA can therefore be considered safer and more effective in providing comfort and amnesia.

Usefulness and safety of double endoscopy in children with gastroesophageal reflux and respiratory symptoms

Management of children with gastroesophageal reflux disease (GORD) and difficult-to-treat (D-T-T) respiratory symptoms may include double fiberoptic, airway and oesophago-gastro-duodenoscopies (DE). A study was performed to evaluate the usefulness and safety of DE in children with severe GORD and D-T-T respiratory symptoms. A 3-year retrospective review of records of children who underwent DE under general anaesthesia was performed: the relevant clinical information obtained and the occurrence of complications in the 72h following the DE. Inflammatory changes of the airways were found at bronchoscopy in 40 out of the 60 children: bronchoalveolar lavage (BAL) demonstrated positive lipid-laden alveolar macrophages (LLAM), neutrophilic inflammation or both, respectively in 9, 12 and 16 patients. BAL bacterial cultures were positive in 2 patients with elevated airway neutrophilia. Structural airway abnormalities, explaining not GOR-related D-T-T respiratory symptoms were identified in 11 patients. Oesophagoscopic findings supporting GORD were detected in 32/60 children and confirmed by consistent histological changes in oesophageal mucosal biopsies (OEB) in 27. The frequency of complications, all minor, was low during the procedure and in the following 72h. They included mild desaturation, stridor or bronchospasm, vomiting, dysphagia and hyperthermia requiring antibiotic treatment in 1 patient. No "new onset" complication was observed after 48h following DE. The time-dependent hazard of complications was significantly higher for patients with a history of onset of respiratory symptoms early in life (</=2 years of age) (p=0.038). DE can be useful in the clinical evaluation of children with D-T-T respiratory symptoms and GORD and is associated with low frequency of mild complications when performed by appropriately trained and experienced personnel.

Diagnostic Endoscopy in Children of Two Months to 15 Years of Age

Problem statement: Considering high prevalence of gastrointestinal complaints in children and the important role of endoscopy in the diagnosis of such complaints, this study was designed to characterize the clinical, endoscopic and pathologic features of Iranian children undergoing upper Gastrointestinal (GI) endoscopy. Approach: This prospective study was performed in an office-based setting in a private medical centre in Kerman, Iran, between December 2004 to January 2008. Three hundred forty pediatric patients who underwent upper endoscopy for dyspeptic symptoms or other reasons were enrolled into this study and data were gathered concerning age, sex, reason of endoscopy, endoscopy report and pathologic report. Upper GI endoscopy was performed using Pentax video endoscope. Results: The most prevalent reason of performing endoscopy (43.1%) was abdominal pain. More than half of the cases with abdominal pain (54%) were in the age range of 5-10 year old of whom 80% had an abnormal pathologic finding such as esophgitis and active chronic gastritis associated with helicobacter pylori. The most common endoscopic finding (31.2%) and pathologic finding (40.3%) was esophagitis. More than half of the children with esophagitis (56.6%) had some degrees of hiatal hernia. In 35.5% of children with nodular gastritis, simultaneous esophagitis was observed. The rate of normal endoscopies and pathologies were respectively 10.8 and 19.4%. Conclusion: Considering low rate of normal endoscopic and pathologic reports in the studied subjects and also the variety of gastrointestinal complaints in them, it seems that proper selection of patients for undergoing upper GI endoscopy can have a significant directive role in the diagnosis of pediatric problems.

Flexible Upper Videoendoscopy Through a Modified Endoscopy Mask in Infants and Young Children

Esophagogastroduodenoscopy (EGD) is considered an essential diagnostic and therapeutic procedure in the pediatric population. Although generally safe, EGD has the potential for airway complications. We routinely use general anesthesia to carry out EGD in patients younger than 10 years. In the past, these patients received oxygen either through a nasal cannula or were intubated; both modalities have drawbacks and may be associated with complications. Here we report our experience using a modified endoscopy mask, devised primarily for bronchoscopy, for upper endoscopy in children under general anesthesia. Two hundred forty children (122 boys and 118 girls) participated in the study. Age range was 7 to 135 months (mean 60.7 +/- 34.4 months). All patients maintained a stable hemodynamic status throughout the procedure. Ventilation was satisfactory in 230 patients. It was difficult in 9 patients, and external airway maneuvers had to be applied. Ventilation was impossible in only 1 patient (10 months old), and endotracheal intubation was performed. There were no procedure-related complications. The modified endoscopy mask is efficient and safe and should be recommended for routine use for upper endoscopy under general anesthesia in children older than 6 months.

Platelet count in predicting bleeding complication after elective endoscopy in children with portal hypertension and thrombocytopenia

Background: Thrombocytopenia is a frequent and challenging clinical disorder in patients with portal hypertension. It can increase the risk of bleeding associated with invasive procedures. Standard treatment for thrombocytopenia usually consists of platelet transfusions, which may cause transfusion-related complications including viral or bacterial infection, allo-immunization and febrile non-hemolytic reactions. Uncertainty still exists as to the platelet level at which transfusion is indicated in conjunction with invasive procedures such as endoscopy. Objective: To determine the predictive value of platelet level for post elective endoscopy bleeding in children with portal hypertension and thrombocytopenia. Patients and methods: Children with portal hypertension and thrombocytopenia (platelet count <100,000 per μL) were enrolled. Those who had active gastrointestinal (GI) bleeding at the time of admission were excluded. All patients underwent elective upper GI endoscopy for esophagogastric varices surveillance and tested for complete blood count. Results: There were 41 children (male:female = 20:21) with portal hypertension enrolled in this study. Age ranged from 2-16 years (mean±SD = 8.42±4.32 years). The etiology of portal hypertension was biliary atresia in 19 and extra-hepatic portal vein obstruction in 22. Thirty of 41 experienced previous upper GI bleeding. Endoscopic finding was 32 esophageal varices (EVs), two EVs plus gastric varices, and seven without varices. Twenty-one patients underwent endoscopy without therapeutic procedure and 20 went through endoscopic variceal ligation. Two patients developed GI bleeding post endoscopy. Platelet count of children with and without post endoscopy bleeding was not significantly different (68,500±40,305 vs. 73,025±24,030/μL, respectively; p=0.8). By applying receiver operating characteristic (ROC) curves, a platelet count cut-off value of 41,500/μL was obtained, which gave positive and negative predictive values of 12.5% and 96.9%, respectively. The accuracy of this cut-off value as evaluated by applying ROC curves was 80.5%. Conclusion: Patients with platelet count of more than 40,000/μL were almost certainly safe to undergo elective endoscopy without prophylactic platelet transfusions and hence minimize the cost and complications of transfusion.