Pediatric Gastrointestinal Endoscopy Research Articles

Practical Pediatric Gastrointestinal Endoscopy ‐ By George Gershman and Marvin Ament

Practical Pediatric Gastrointestinal Endoscopy ‐ By George Gershman and Marvin Ament

Sedation and Anesthesia in Pediatric Endoscopy: One Size Does Not Fit All

Sedation and Anesthesia in Pediatric Endoscopy: One Size Does Not Fit All

Changes in Pediatric Gastrointestinal Endoscopy: Review of a Recent Hospital Experience

Changes in Pediatric Gastrointestinal Endoscopy: Review of a Recent Hospital Experience

P0804 A PILOT STUDY OF PROPOFOL ANAESTHESIA FOR PAEDIATRIC ENDOSCOPY WITHOUT TRACHEAL INTUBATION

Introduction: Propofol is widely used in anaesthesia for short procedures but there is limited evidence for its use in children undergoing endoscopy. The aim of this pilot study was to investigate the efficacy and safety of propofol as a single agent anaesthetic agent for paediatric gastrointestinal endoscopy without endotracheal intubation. We compared this with our current practice of conscious sedation using low dose midazolam and pethidine Methods: A prospective randomised trial with two groups in parallel was performed on 49 children. Entry criteria were all children deemed to be safe for deep sedation endoscopy. 32 patients (age 1.1 -15 years median 6.4 yrs) were given midazolam (0.1–0.2mg/kg) /pethidine (1–2mg/kg). 17 children (1.5 to 14 yrs, median 7.2 yrs) were recruited to have propofol anaesthesia. A single observer carried out the observations in the table Results: 16 out of 17 children tolerated the procedure under Propofol of 3–6 mg/kg. 1 child needed a maximum of 9mg/kg. Airway support was unnecessary. See table 1.Table 1Conclusion: Our data shows that anaesthesia with Propofol without tracheal intubation is safe. It is well tolerated by patients and provides excellent sedation for efficient endoscopic evaluation with short recovery times.

Sedation, safety and utility of pediatric gastrointestinal endoscopy—The scope 2000 report

Sedation, safety and utility of pediatric gastrointestinal endoscopy—The scope 2000 report

SEDATING PEDIATRIC PATIENTS FOR GASTROINTESTINAL ENDOSCOPY PROCEDURES: DOSAGE RANGES FREQUENTLY EXCEED RECOMMENDED GUIDELINES

99 Aims: Several national organizations have been involved in the development of guidelines for pediatric sedation Numerous references recommend dosage ranges for medications used for pediatric sedation. Are these doses appropriate for children undergoing gastrointestinal endoscopy? The aims of this study were to determine: 1) Are recommended guidelines for pediatric sedation adequate for endoscopy procedures? 2) What were the dosage ranges used by pediatric gastroenterologists? 3) If dosage ranges were exceeded, were any complications identified? Methods: Dosages of sedatives administered by 6 pediatric gastroenterologists in 41 procedures were retrospectively reviewed. Ages of children ranged from 1 month to 18 years. Individual physicians titrated the doses of medications to achieve adequate sedation. Medications used by all physicians included meperidine, midazolam, and diazepam. Diphenhydramine, promethazine, chlorpromazine and chloral hydrate were also used by some physicians. The total dosage for each medication administered was compared to our institutional guidelines (based on ranges found in standard references). All patients were monitored according to AAP recommendations, including continuous pulse oximetry, documentation of vital signs and continuous assessment by a nurse whose sole responsibility was to monitor the patient. Each case was reviewed for adverse events, which were defined as patient responses which necessitated intervention (i.e. supplemental O2 administration, tactile stimulation, transfer to the intensive care unit, overnight hospitalization). Results: 22/38(58%) of meperidine doses, 16/35 (46%) of midazolam doses, and 4/9 (45%) of diazepam doses exceeded the recommended mg/kg doses. Statistical analysis demonstrated (in mg/kg): Meperidine range 0.2-6.5, mean ± S.D.=2.58±1.3. Midazolam range 0.07-0.6, mean ± S.D.=0.19±0.11. Diazepam range 0.06-0.36, mean ± S.D.=0.2±0.1. Meperidine was always administered with at least one of the benzodiazepine medications. Doses were titrated over 1 to 72 min (average 18min). There was one adverse event, in which the patient's oxygen saturation decreased to 88% and the child was difficult to arouse. This event occurred 15 minutes after the completion of the procedure and resolved spontaneously. No endoscopy was aborted due to complications from sedation or the procedure itself. Conclusions: 1) Sedation required for pediatric gastrointestinal endoscopy procedures frequently exceeds recommended guidelines, suggesting that these guidelines may need to be modified. 2) Adverse events were rarely noted when recommended guidelines were exceeded. 3) Patient monitoring is essential and must be continued until the patient reaches baseline assessment.

Conscious sedation with high-dose midazolam for pediatric gastrointestinal endoscopy.

Midazolam is used frequently to sedate children for gastrointestinal endoscopy. The sedative dosage of intravenous midazolam commonly reported in children is up to 0.3 mg/kg. We hypothesized that larger doses of midazolam could be used for pediatric endoscopy. We retrospectively reviewed the medical records of 116 pediatric patients (aged 1 year to 18 years) who had endoscopy. The efficacy and side effects of sedation in 45 patients who received midazolam doses of > or = 0.3 mg/kg were compared with the same effects in 71 children who received < 0.3 mg/kg. All patients received approximately 1 mg/kg meperidine (up to 50 mg) intravenously. The blood pressure, pulse rate, respiratory rate, oxygen saturation, degree and duration of sedation, and incidence of side effects such as hypotension, hypoxia, or vomiting were similar in both groups. Intravenous doses of midazolam > 0.3 mg/kg can be used for conscious sedation in children.

Paediatric upper gastro-intestinal endoscopy in developing countries.

A retrospective study of 200 endoscopies performed on 168 children (90 girls and 78 boys) aged 3 months to 18 years (median 6 years) is reported. All procedures were completed successfully in an adult endoscopy unit in a comprehensive health centre. Most children of less than 6 months and above 12 years of age needed no intravenous sedation. One child developed respiratory depression and was successfully resuscitated. Indications for endoscopy were: small intestinal biopsy, 78 (46%); recurrent abdominal pain, 40 (24%); acute epigastric pain, 13 (8%); persistent vomiting, 12 (7%); haemorrhage, 10 (6%); caustic substance ingestion, six (4%); and dysphagia, four (2%) children. Positive diagnoses were obtained in 123 (62%) procedures. Coeliac disease (26 cases) was the most common histological diagnosis, followed by gastritis (19 cases), oesophagitis (18 cases), duodenitis (16 cases), duodenal ulcer (11 cases), hiatus hernia (six cases), gastric ulcer (three cases) and oesophageal stricture (two cases). Where specialized paediatric endoscopy units are not feasible, e.g. in developing countries, endoscopic services for children can be safely provided by paediatric endoscopists as part of an adult endoscopy service, provided that suitable resuscitation equipment is available and the necessary modifications to meet the medical and psychological needs of children and their parents are taken into consideration.

Routine jejunal endoscopic biopsy in children.

The aim of the study was to evaluate and compare two methods of jejunal biopsy-endoscopic (EB) and suction (SB). Jejunal EB was performed using an Olympus GIF P20 endoscope in 119, and SB with a modified Crosby capsule in 254 patients. A light microscope with micrometer was used for the analysis and measurement of biopsy specimens. Calculated per patient, the total average number of all adequate specimens was: jejunal or duodenal mucosa -2.97 in EB and 0.93 in SB; jejunal mucosa only -2.82 in EB and 0.89 in SB group. Duodenal mucosa was unintentionally biopsied in 17.1% of EB and in 3.7% of SB. Jejunal mucosal specimens were selected for measurement at random -82 from the EB and 24 from the SB group. The difference in height between EB and SB specimens was not significant (EB: 0.72 +/- 0.13 mm; vs SB: 0.77 +/- 0.14 mm). The difference in length was significant (EB: 2.57 +/- 1.24 mm; vs SB: 3.22 +/- 1.38 mm; P = 0.03). The advantages of the EB over the SB technique included elimination of fluoroscopy, no failures in obtaining biopsies and a 97% success rate in obtaining specimens adequate for histological analysis. It also enabled the biopsy site to be chosen and several specimens to be taken, providing additional tissue for various analyses. Jejunal endoscopic biopsy is suggested as a good alternative to the suction biopsy, wherever paediatric upper gastrointestinal endoscopy is available.

Indications for pediatric gastrointestinal endoscopy: a medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition.

Indications for pediatric gastrointestinal endoscopy: a medical position statement of the North American Society for Pediatric Gastroenterology and Nutrition.

Paediatric gut endoscopy

In the past 2 decades, paediatric gastro-intestinal (GI) endoscopy has gained increasing acceptance, establishing itself as an indispensible procedure in the diagnosis and management of many common GI problems in childhood. There are three main reasons for its popularity: 1. It allows direct examination of the inside of the upper and lower GI tract and is therefore often more accurate than the indirect examination offered by imaging studies. 2. Biopsy for histology and microbiology can be performed. 3. Therapeutic manoeuvres are possible. In experienced hands, both the safety and effectiveness of the procedure are well proven.X In addition, new applications are emerging all the time. Endoscopy can be rigid or flexible.