Pediatric Gastrointestinal Endoscopy Research Articles

Which Alarm Symptoms Are Associated With Abnormal Gastrointestinal Endoscopy Among Thai Children?

Alarm symptoms (red flag signs) are crucial indications for management decisions on pediatric gastrointestinal endoscopy. We aimed to identify items in the alarm symptoms and pre-endoscopic investigations that predict abnormal endoscopy results. A retrospective descriptive study was conducted among children aged under 18 years undergoing endoscopy. The patients were classified into normal and abnormal endoscopic groups. The incidence of alarm symptoms and pre-endoscopic investigations were compared between the groups. Univariate and multivariate logistic regression analyses were performed to determine independent risk factors for abnormal endoscopy. Of 148 participants, 66 were classified in the abnormal endoscopy group. Compared with the normal group, the abnormal group had a significantly higher prevalence of alarm symptoms. Moreover, hematemesis/hematochezia, anemia, low hemoglobin level, hypoalbuminemia, rising erythrocyte sedimentation rate, increased serum lipase, and blood urea nitrogen/creatinine ratio were significantly higher in the abnormal endoscopy group than in the normal group. Multivariate logistic regression analysis indicated that hematemesis/hematochezia and low hemoglobin level were independent risk factors for abnormal endoscopy. The alarm symptoms and pre-endoscopic investigations were evaluated using predictive factors for abnormal pediatric endoscopic findings. According to multivariate logistic regression analysis, hematemesis/hematochezia and low hemoglobin levels were independent risk factors for abnormal endoscopy.

The relationship between gastric ultrasound findings and endoscopically aspirated volume in infants and determining the antral cutoff value for empty stomach diagnosis.

Pulmonary aspiration of gastric content is a serious perioperative complication. The objective of this prospective study was to assess the relationship between the gastric volumes suctioned endoscopically and quantitative (antral cross-section area) and qualitative (empty vs. nonempty) examination of the gastric antrum. Furthermore, the study aimed to determine the best antral cross-section area cutoff value for a truly empty antrum in infants. This study was performed in a pediatric gastrointestinal endoscopy unit. Antral sonography was performed in supine and right lateral decubitus positions in 46 fasted infants prior to upper gastrointestinal endoscopic evaluation. Antral cross-sectional area measurements in both positions and qualitative evaluation of the antrum (according to a three-point grading system) were recorded. Gastric contents were endoscopically suctioned and measured. Forty-six patients (aged under 24 months) were included. According to the three-point qualitative grading system, 76.1% of patients were classified as grade 0. The best cutoff value for the antral cross-section area in the right lateral decubitus position, indicating an empty antrum, was determined to be 2.40 cm2. At this specific cutoff value, the sensitivity was 100%, the specificity was 68.6%, and the negative predictive value was 100%. Gastric ultrasonography can confirm an empty or nearly empty stomach in healthy infants.

Promoting Research that Supports High-Quality Gastrointestinal Endoscopy in Children.

Defining and measuring the quality of endoscopic care is a key component of performing gastrointestinal endoscopy in children. The purpose of this review is to discuss quality metrics for pediatric gastrointestinal endoscopy and identify where additional research is needed. Pediatric-specific standards and indicators were recently defined by the international Pediatric Endoscopy Quality Improvement Network (PEnQuIN) working group through a rigorous guideline consensus process. Although the aim of these guidelines is to facilitate best practices for safe and high-quality gastrointestinal endoscopy in children, they highlight the pressing need to expand upon the body of evidence supporting these standards and indicators as predictors of clinically relevant outcomes. In this review, we propose and discuss ideas for several high-yield research topics to engage pediatric endoscopists and promote best practices in pediatric endoscopy.

Pediatrik Gastrointestinal Endoskopi Ünitesinde Çalışan Endoskopi Hemşirelerinin Anestezi Yönetimi Konusundaki Farkındalığı; Bir Anket Çalışması

Objective: We aimed to determine the awareness and knowledge levels of endoscopy nurses working in Pediatric Gastrointestinal Endoscopy units on anesthesia applications they encountered in clinical practice. Material and Methods: Endoscopy nurses that work in Pediatric Gastrointestinal Endoscopy units in Turkey were invited to this study. Among the 33 questions, seven were in the section questioning the endoscopy nurses’ demographics and occupational working time (Section 1). In the other part, 16 questions were asked about what should be known during the anesthesia administration and recovery process (Section 2). The remaining 10 questions were statements that determined the level of awareness regarding anesthesia practices in pediatric GI endoscopy units. (Section 3) Results: The total of 80 participants’ mean age was 40.3±9.1 years, and 91.3% were female. Seventy seven percent of the participants replied “yes” to the statement of “The endoscopy nurse should be able to evaluate possible complications by considering the ASA classification of the patients.” Thirty five percent of participants knew about the Modified Aldrete Scoring system. The mean age, total working time, and working time in the pediatric GI endoscopy unit were found to be lower in those who agreed with the statement "Patients can be discharged with their parents/caregiver without any scoring or criteria evaluation two hours after the procedure" Conclusion: In conclusion, although the pediatric endoscopy nurse is not responsible for anesthesia management practices, their awareness and knowledge about anesthesia management play a key role for the endoscopy and the anesthesia team in ensuring patient safety.

Training in Pediatric Gastrointestinal Endoscopy during Surgery Residency: Can Training Programs Currently Educate Proficient Pediatric Endoscopists? A Nationwide Assessment

Background: Technological advances in pediatric gastrointestinal (GI) endoscopy require highly specialized physicians. Therefore, proper training is fundamental. The aim of this study was to assess the level of competence of pediatric surgery residents to determine areas that should be addressed to design better training programs focused on pediatric GI endoscopy. Methods: An observational study was performed on all Italian pediatric surgery trainees that concluded the training program by the end of 2021, who were asked to answer a questionnaire about the quality of the GI endoscopy education received during their 5 years of residency. Results: 12 out 14 (86%) pediatric surgery trainees answered the questionnaire. A total of 50% (6/12) of the trainees declared they were interested in pediatric GI endoscopy, and 42% (5/12) said that they would be interested in dedicating themselves to this discipline in the future. Only 33% (4/12) of them were in a center equipped with endoscopy simulators. Among them, 17% (2/12) never took part in GI endoscopic procedures while working in centers in which GI endoscopy is performed exclusively by pediatric gastroenterologists, 25% (3/12) had never performed GI endoscopic procedures as a first operator and 17% (2/12) not even as assistant. Overall, 50% (6/12) were not satisfied with the level of education received and only 17% (2/12) declared that they felt confident enough to perform routine endoscopies alone. Conclusions: Our study highlights great inhomogeneity between different schools and some important failings. Better programs should be designed to educate proficient pediatric GI endoscopists.

A journey towards pediatric gastrointestinal endoscopy and its training: a narrative review.

Gastrointestinal (GI) endoscopy in pediatric setting has unique features and, therefore, requires an approach that is tailored to pediatric practice. There is still heterogeneity between training programs worldwide in terms of duration, number of procedures and assessment during and at the end of the training process. We conducted a narrative review aiming to describe and summarize the existing literature on the various training methods for pediatric GI endoscopy to highlight the significance of specific pediatric endoscopy training. Simulation-based tools have been implemented in several training programs, providing a safer learning environment for trainees, especially in their earlier stages of training. Assessment of competence is gradually shifting from the sole evaluation of procedural numbers towards the development of more reliable and valid tools that can accurately measure technical competence. Despite such seismic shift, there is still a need for a standardized and comprehensive pediatric-oriented endoscopy curriculum that incorporates acquisition of procedural skills education and is built on the current competency-based model of training. All the above must sink their roots in trainees and to ensure that the endoscopists of tomorrow are capable of delivering high quality of care for children undergoing endoscopy. It is crucial to parallelly focus on the way trainers teach trainees. In this context, the implementation of "train the trainers" courses has improved important quality meters in GI endoscopy. Future research should put the focus on the potential subsequent favorable benefits of these changes on child health.

Identification of iatrogenic perforation in paediatric gastrointestinal endoscopy.

Iatrogenic viscus perforation in paediatric gastrointestinal endoscopy (GIE) is a very rare, yet potentially life-threatening event. There are no evidence-based recommendations relating to immediate post-procedure follow-up to identify perforations and allow for timely management. This study aims to characterize the presentation of children with post-GIE perforation to better rationalize post-procedure recommendations. Retrospective study based on unrestricted pooled data from centers throughout Europe North America and the Middle East affiliated with the Endoscopy Special Interest Groups of European Society for Paediatric Gastroenterology Hepatology and Nutrition and North American Society for Pediatric Gastroenterology Hepatology and Nutrition. Procedural and patient data relating to clinical presentation of the perforation were recorded on standardized REDcap case-report forms. Fifty-nine cases of viscus perforation were recorded (median age 6 years (IQR 3-13)). 29/59 (49%) occurred following esophagogastroduodenoscopy (EGD), 26/59 (44%) following ileocolonoscopy, with 2/59 (3%) cases each following balloon enteroscopy and ERCP.28/59 (48%) of perforations were identified during the procedure (26/28 (93%) endoscopically, 2/28 (7%) by fluoroscopy), a further 5/59 (9%) identified within 4 hours. Overall 80% of perforations were identified within 12 hours.Amongst perforations identified subsequent to the procedure 19/31 (61%) presented with pain, 16/31 (52%) presented with fever and 10/31 (32%) presented with abdominal rigidity or dyspnea.30/59 (51%) were managed surgically, 17/59 (29%) managed conservatively and 9/59 (15%) endoscopically. 4/59 (7%) patients died, all following esophageal perforation. Iatrogenic perforation was identified immediately in over half of cases and in 80% of cases within 12 hours. This novel data can be utilized to generate guiding principles of post-procedural follow-up and monitoring.

Paediatric gastrointestinal endoscopy in the Asian-Pacific region: Recent advances in diagnostic and therapeutic techniques.

There has been a rapid expansion in the knowledge of paediatric gastroenterology over the recent decade, with a fast-growing repertoire of diagnostic techniques and management strategies for a wide spectrum of childhood gastrointestinal (GI) diseases. Paediatric GI endoscopy is a core competency every paediatric gastroenterologist should possess, and represents one of the most common procedures performed in children for both diagnostic and therapeutic purposes. Yet there remains a dearth of literature on the utility and outcomes of paediatric GI endoscopy in the Asia-Pacific region. Data on the diagnostic value of paediatric GI endoscopy would be an important aspect of discussion, with the emergence of inflammatory bowel disease (IBD) and eosinophilic GI disease as increasingly common endoscopic diagnoses. Time-based trends in paediatric GI endoscopy do point towards more IBD and gastroesophageal reflux disease-related complications being diagnosed, with a declining incidence of GI bleeding. However, the real-world diagnostic value of endoscopy in Asia must be contextualised to the region-specific prevalence of paediatric GI diseases. Helicobacter pylori infection, particularly that of multidrug-resistant strains, remains a highly prevalent problem in specific regions. Paediatric functional GI disorders still account for the majority of childhood GI complaints in most centres, hence the diagnostic yield of endoscopy should be critically evaluated in the absence of alarm symptoms. GI therapeutic endoscopy is also occasionally required for children with ingested foreign bodies, intestinal polyposis or oesophageal strictures requiring dilation. Endoscopic haemostasis is a potentially life-saving skill in cases of massive GI bleeding typically from varices or peptic ulcers. Advanced endoscopic techniques such as capsule endoscopy and balloon-assisted enteroscopy have found traction, particularly in East Asian centres, as invaluable diagnostic and therapeutic tools in the management of IBD, obscure GI bleeding and intestinal polyposis. State of the art endoscopic diagnostics and therapeutics, including the use of artificial intelligence-aided endoscopy algorithms, real-time confocal laser endomicroscopy and peroral endoscopic myotomy, are expected to gain more utility in paediatrics. As paediatric gastroenterology matures as a subspecialty in Asia, it is essential current paediatric endoscopists and future trainees adhere to minimum practice standards, and keep abreast of the evolving trends in the diagnostic and therapeutic value of endoscopy. This review discusses the available published literature on the utility of paediatric GI endoscopy in Asia Pacific, with the relevant clinical outcomes.

Anxiety of parents and children undergoing gastrointestinal endoscopy correlates with sedative doses

Aim: Sedation is a fundamental component of the pediatric gastrointestinal endoscopy (GIE). The dosing of drugs to be used for sedating the child is an important aspect of the efficacy and safety of procedural sedation. Besides, outpatient procedures are stressful situations for pediatric patients and also their families, and therefore, parental anxiety may affect children indirectly. The first aim of the study was to assess the association between parental anxiety and required sedative dose in children undergoing GIE. The second aim was to assess the factors associated with children’s preoperative anxiety. 
 Material and Method: This study was a prospective, observational, and single-center study performed by the same fellowship-trained pediatric gastroenterology specialist and the same anesthesiology specialist. Parental anxiety was evaluated with the State-Trait-Anxiety-Scale (STAI) and children's anxiety was evaluated with the Modified Yale Preoperative Anxiety Scale (mYPAS). Midazolam, ketamine, propofol, and fentanyl were administered for the children’s sedation. There were 2 comparisons in this study, the anxiety of parents according to mean STAI scores, and anxiety of children according to mYPAS scores. 
 Results: Of 120 children and parents, 87 parents (73%) and 57 children (48%) had high anxiety. Of 120 parents, 111 parents (92%) were mothers of the children. Younger children had higher anxiety levels. Before and the start of the GIE heart rates of children were higher both in the high anxiety group of parents and children. In sedatives, high anxiety parents’ children and high anxiety children were required more ketamine dosages. (p

The Yield of Routine Tissue Sampling in Pediatric Gastrointestinal Endoscopy.

Societies' guidelines suggest routine tissue sampling in all children undergoing esophagogastroduodenoscopy and ileocolonoscopy, even in the absence of visible endoscopy abnormalities. We aimed to determine the agreement between endoscopic and histopathological findings in pediatric endoscopy and to assess the yield of routine biopsies from all sites. Since January 2019, our endoscopy institute protocol has included routine biopsies sampling from the esophagus, stomach, duodenum, ileum, and colon in all diagnostic procedures. Agreement between tests was done using the kappa coefficient ( κ ). The study included all endoscopies performed during 2019. In total, 541 diagnostic endoscopies were done during the study period with 434 (80%) esophagogastroduodenoscopy and 107 (20%) were ileocolonoscopy. Compared to histology, endoscopic findings performance were: esophagus-sensitivity 33%, specificity 98%; stomach-sensitivity 60%, specificity 89%; duodenum-sensitivity 50%, specificity 97%; duodenal bulb-sensitivity 47%, specificity 89%; terminal ileum-sensitivity 82%, specificity 100%; colon-sensitivity 84%, specificity 96%. Assessment of concordance between endoscopic and histopathologic findings reveals an overall low level of agreement in esophagogastroduodenoscopy ( κ of 0.39, 0.51, 0.53, and 0.24 for the esophagus, stomach, duodenal second part, and bulb, respectively), and good agreement in ileocolonoscopy ( κ of 0.88 and 0.81 for the ileum and colon, respectively). Endoscopy findings are highly specific for histologic pathology, whereas the absence of findings correlates poorly with histologic findings. Ileocolonoscopy shows better agreement than esophagogastroduodenoscopy. Our data support routine tissue sampling in pediatric endoscopy.

Impact of the Coronavirus Disease 2019 Pandemic on Pediatric Gastrointestinal Endoscopy: A Questionnaire-based Internet Survey of 162 Institutional Experiences in Asia Pacific.

The impact of coronavirus 2019 (COVID-19) on gastrointestinal (GI) endoscopy procedures in adults has been reported, with a drastic reduction in the number of procedures. However, there are no sufficient data regarding the impact on pediatric GI endoscopy. Here, we aimed to report that impact in the Asia-Pacific region. A questionnaire-based internet survey was conducted from June to November 2021 among pediatric endoscopy institutions in the Asia-Pacific region, with each institution providing a single response. Overall, 25 questions focused on the impact of the number of procedures conducted, the usage of personal protective equipment (PPE), and endoscopy training programs during the pandemic. A total of 162 institutions across 13 countries in the Asia-Pacific region participated in the study, and 133 (82.1%) institutions underwent procedure changes since the emergence of COVID-19. The number of esophagogastroduodenoscopy and ileocolonoscopy procedures decreased in 118/133 (88.7%) and 112/133 (84.2%) institutions, respectively. Endoscopy for patient with positive COVID-19 in an emergency or urgent cases still carried out in 102/162 (62.9%) institutions. Screening of COVID-19 for all patients before endoscopy was done across 110/162 (67.9%) institutions. PPE recommendations varied among institutions. Pediatric gastrointestinal endoscopy training programs were discontinued in 127/162 (78.4%) institutions. This study reports the impact of the COVID-19 pandemic on pediatric gastrointestinal endoscopy in the Asia-Pacific region. There has been a significant reduction in the number of endoscopic procedures and relevant training programs.

Procedural Sedation Protocols with or without Ketamine in Pediatric Gastrointestinal Endoscopy: A Retrospective Cohort Study

Procedural Sedation Protocols with or without Ketamine in Pediatric Gastrointestinal Endoscopy: A Retrospective Cohort Study

A 2-week intensive gastrointestinal endoscopy training program for pediatricians.

In Japan there are limited opportunities for pediatricians to learn gastrointestinal (GI) endoscopy. This study investigated whether a short-term intensive training for 2 weeks in an adult GI setting enabled pediatricians to acquire basic technical competence for pediatric GI endoscopic procedures. This was a retrospective case series of pediatricians who underwent 2 weeks of intensive endoscopy training at an adult endoscopy unit in a community hospital. The numbers of esophagogastroduodenoscopy (EGD) and ileocolonoscopy procedures each pediatrician performed were evaluated. All enrolled pediatricians were asked to answer questionnaires regarding the 2 week intensive GI endoscopy training program. There were 17 enrolled pediatricians, of whom 13 were men; average age 32 years (range 27-54). The median (range) numbers of EGDs and ileocolonoscopies performed by each pediatrician during the 2-week training period were 102 (66-144) and 14 (1-48), respectively. Fifteen out of 17 pediatricians experienced more than 100 GI endoscopies during the 2 weeks. All pediatricians performed biopsies as part of some EGD procedures. All 17 pediatricians found this program satisfactory. All pediatricians became cable of performing pediatric EGD (i.e., for children ≤15 years) after this training program. Sixteen pediatricians have continued to perform pediatric GI endoscopy since this training program. A short-term intensive training program for 2 weeks in an adult GI setting enabled pediatricians to acquire basic technical competence for pediatric endoscopic procedures.

Paediatric Gastrointestinal Endoscopy in a Nigerian Tertiary Hospital

Background: Gastrointestinal endoscopy is a very useful tool in the diagnosis and treatment of gastrointestinal disorders. Gastrointestinal endoscopy in paediatric practice is still evolving in Nigeria. Objective: To determine the common indications for paediatric endoscopy in a Nigerian tertiary hospital. Method: This was a retrospective study of all gastrointestinal endoscopic procedures performed for children aged 0 -18 years between January 2021 and March 2022. The hospital records of the children were retrieved, and data were extracted for analysis. Results: Thirty-seven endoscopic procedures were performed on 32 children with two subjects having repeated procedures while one had both upper and lower gastrointestinal endoscopic studies. The mean age of the children was 11 ± 5.4 years with those aged between 10 and 14 years constituting the majority (40.6%). Most indications were diagnostic and the commonest indication for endoscopy was upper abdominal pain (40.6%) which was followed by upper gastrointestinal bleeding (37.6%). The endoscopic findings were mainly gastritis (56.8%), hiatus hernia (32.4%) and duodenitis (18.9%). The commonest therapeutic indication for gastrointestinal endoscopy was variceal banding. Conclusion: Paediatric gastrointestinal endoscopy is useful for the diagnosis and treatment of paediatric gastrointestinal disorders. Upper abdominal pain and upper gastrointestinal bleeding are the leading indications for paediatric gastrointestinal endoscopy in Nigeria.

Paediatric gastrointestinal endoscopy: Experience in Red Cross War Memorial Children’s Hospital, Cape Town, South Africa


 Background. Endoscopy is an important diagnostic and therapeutic mode of management in children with gastrointestinal disorders.
 Objective. To determine the indications, endoscopic yields and impact of the service on the ongoing health and complications among children who underwent gastrointestinal endoscopy at Red Cross War Memorial Children’s Hospital, Cape Town.
 Methods. A 10-year (2007 - 2016) retrospective study of children <18 years old who underwent gastrointestinal endoscopy was undertaken using relevant patients’ variables obtained from their hospital medical records. Data were analysed using Stata 13.1 (p<0.05).
 Results. A total of 402 children underwent a total of 695 gastrointestinal endoscopic procedures: 592 (85.2%) were gastroscopies, 78 (11.2%) combined gastroscopies with colonoscopies and 25 (3.6%) colonoscopy-only procedures, respectively. The main diagnostic indications for gastroscopy, gastroscopy combined with colonoscopy and colonoscopy-only were chronic abdominal pain (n=49; 12.2%), suspected inflammatory bowel disease (n=30; 7.5%) and rectal bleeding (n=13; 52.0%) respectively. The most common therapeutic indication for gastroscopy was change of a percutaneous endoscopic gastrostomy (n=143; 35.6%) while for colonoscopy 6 (5.8%) had polypectomy. Abnormal histopathological results were made from both macroscopically normal- and abnormal-looking tissues, though with no statistically significant relationship.
 Conclusion. Endoscopy offers diagnostic and therapeutic options in children. Positive histological findings were obtained in some cases where gastrointestinal mucosae appeared normal. There is need to obtain biopsies from both macroscopically normal- and abnormallooking gastrointestinal mucosae as positive histological findings could be made from them and hence improve diagnostic yield.

Practices in Paediatric Gastrointestinal Endoscopy at Kenyatta National Hospital and Gertrude’s Children’s Hospital in Nairobi, Kenya

Background: Gastrointestinal (GI) diseases are common in children worldwide and pediatric GI endoscopy has become a fundamental component of healthcare for infants and children. There is a wide range of diagnostic and therapeutic indications for pediatric upper and lower GI endoscopy as well as new diagnostic and therapeutic interventions for the endoscopic findings Objectives: To document the indications, endoscopic findings and therapeutic procedures in pediatric upper and lower gastrointestinal endoscopy at the Kenyatta National Hospital (KNH) and Gertrude’s children’s hospital. Design: Cross-sectional, consecutive entry study Setting: Kenyatta National Hospital and Gertrude’s children’s hospital Materials and Methods: This study was done over a period of 5 months involving participants of age 13 years and below who underwent GI endoscopy at the endoscopy units of KNH and Gertrude’s children’s hospital. The subjects who met the eligibility criteria were recruited by the Principal Investigator through consecutive sampling. Data was recorded in a data abstraction form. Permission to undertake the study was obtained from the combined institutional Research and Ethics Committee (IREC) of KNH and University of Nairobi as well as the Ethics Review Board of Gertrude’s Children Hospital.Data was anonymized prior to analysis. Written informed consent for the study was obtained from the participants’ parents or guardians. The data collected was coded and entered in MsAccess data base. Data cleaning was done and the data exported into SPSS version 23.0statistical software. All statistical tests were performed at 5% level of significance. Results: Mean age of the children was 7.3 years (std=3.9). Males were 58 (52.7%). OGD involved 79.1% of the participants. In KNH, the main indications for OGD (oesophagogastroduodenoscopy) were upper GI bleed and dysphagia while in Gertrude’s hospital, they were abdominal pain and emesis. Hematochezia was the predominant indication for colonoscopy. More study participants had normal than abnormal gross and histological findings. The commonest gastroscopic findings were gastritis and esophagitis. Hiatus hernia was detected in only 4.8% of the children. The commonest colonoscopic finding was colonic polyps. 69(62.7%) patients had results of biopsies taken being present. The commonest positive findings in the colon and rectum were chronic ulcerative colitis and juvenile polyps, respectively. The main therapeutic procedures done were banding for oesophageal varices, FB removal and oesophageal dilatation. Conclusions: The higher percentages of normal gross and histologic findings indicate more a functional than organic etiology to the GI presentations. Hiatus hernia is relatively uncommon in our population. Juvenile polyps are more common than ulcerative colitis as a cause of hematochezia in children. Recommendations: Considerations for higher possibility of functional diagnoses should be made for patients with recurrent abdominal pains and recurrent emesis. Emphasis should be made for parents/guardians of children who require biopsy that histology forms a crucial part of management

The utility and safety of paediatric endoscopy in a district general hospital in Southeast England.

This study was done to evaluate the appropriateness, diagnostic yield, and quality of paediatric gastrointestinal endoscopy in a large DGH with tertiary paediatric gastroenterology services. It was a retrospective cohort study of children who had at least one gastrointestinal endoscopy during 31 months (May 2018-Dec 2020) in a district general hospital in Southeast England. The participants were children (2–17 years). Two hundred ninety-three procedures were performed in total, 80% were diagnostic and 20% for surveillance. The median age was 12 years and 52.5% were males. Oesophago-gastro-duodenoscopy (OGD) corresponded to 79.5% of procedures, ileo-colonoscopy (IC) to 7.2% and the remaining had both procedures. The main diagnostic indication was persistent abdominal pain in 33.5% of cases, followed by suspected GORD (14.8%), recurrent vomiting (14.3%), dysphagia (9.1%) and blood loss per rectum (8.6%). A total of 64.7% showed abnormal macroscopic findings, and 69.2% showed histopathological signs of disease. The most common histological diagnosis was gastritis in 23% followed by coeliac disease in 13%, reflux oesophagitis in 12.2% and inflammatory bowel disease in 9.6%. Procedures were performed with utmost safety with two reported cases of complications, which were appropriately managed. The completion rate of diagnostic IC was 87%. A waiting time of 6 weeks was achieved in 50.4% of cases.Conclusion: Paediatric endoscopy can be safely performed in a district general hospital with the right setup and can aid in the management of gastrointestinal disease in the paediatric patient. It is important to monitor and regularly audit such practices to improve the quality of specialist services.What is Known:• Paediatric endoscopy is predominantly performed in large tertiary centres and included in the diagnostic algorithm for many paediatric gastrointestinal conditions.• There are recommendations on clinical indication endorsed by ESPGHAN and key quality indicators published jointly by JAG and BSPGHAN.What is New:• Paediatric endoscopy can be appropriately and safely performed in district general hospital by trained professionals, decreasing the workload in larger tertiary paediatric centres.• Adoption of regular audit practices is essential to ensure and improve quality and appropriateness of this specialist service.

Nationwide Survey for Pediatric Gastrostomy Tube Placement in Korea.

BackgroundVarious methods have been implemented for pediatric gastrostomy tube placement. We aimed to investigate the performance status of pediatric gastrostomy in South Korea and to present indications and appropriate methods for domestic situations.MethodsA survey was conducted among pediatric endoscopists who performed upper gastrointestinal endoscopy in Korea. The questionnaire consisted of 16 questions on gastrostomy performance status.ResultsAmong the 48 institutions where the survey was applied, 36 (75%) responded. Of the 36 institutions, gastrostomy was performed in 31 (86.1%). The departments in which gastrostomy was performed were pediatrics at 26 institutions (81.3%), surgery at 24 institutions (75.0%), internal medicine at 9 institutions (28.1%), and radiology at 7 institutions (21.9%). There were 18 institutions (66.7%) using the pull method for percutaneous endoscopic gastrostomy (PEG) and nine institutions (33.3%) using the push method. When performing gastrostomies, fundoplication procedures were performed in 19 institutions (61.3%), if deemed necessary. However, 12 institutions (38.7%) answered that gastrostomy was always implemented alone. Complications after gastrostomy included buried bumper syndrome, wound infection, leakage, tube migration, and incorrect opening site in the stomach, but the number of cases with complications was very small.ConclusionIn Korea, a pediatric gastrostomy is implemented in various ways depending on the institution. Clinicians are concerned about choosing the most effective methods with fewer complications after the procedure. In our study, we reported only a few complications. Korea has good accessibility for pediatric gastrointestinal endoscopy, and this survey showed that it is a safe procedure that can be considered initially in pediatric gastrostomy. This study is expected to help to create optimal pediatric PEG guidelines in Korea.

Pediatric Gastrointestinal Endoscopy: Diagnostic Yield and Appropriateness of Referral Based on Clinical Presentation: A Pilot Study.

Objectives: There is a lack of evidence-based consensus for the utility of gastrointestinal endoscopy (GIE) in an array of frequently occurring symptoms in children. We aimed to assess the diagnostic yield of endoscopy in an effort to aid clinical decision making.Methods: Retrospective analysis included patients ≤18 years who underwent GIE during one calendar year at Shaare Zedek Medical Center. We excluded children referred for predefined obvious indications for GIE, planned follow-up procedures, and therapeutic endoscopy. Clinician-assigned indication for endoscopy as well as endoscopic and histologic findings were recorded. Diagnostic yield of GIE was determined according to referral indication.Results: There were 794 endoscopies performed of which 329 were included in the analysis (mean age 9.3 ± 5.0 years, 51% female). No significant complications of GIE were recorded. Six major referral indications were identified among which abdominal pain was the most frequent 88/329 (26%) of whom 32/88 (36%) had a significant diagnostic finding. Among the other major indications, diagnostic findings were found in 36/85 (43%) children with primary indication of chronic diarrhea, 14/33 (42%) failure to thrive, 15/32 (46%) short stature, 30/56 (54%) iron deficiency, and 20/48 (42%) weight loss.Conclusions: Pediatric GIE is a safe procedure with diverse clinical indications. The diagnostic yield of endoscopy is variable, depending on the referral indication. These data can assist formulating judicious referral practices.

Use of Hypnosis in Paediatric Gastrointestinal Endoscopy: A Pilot Study.

Objectives: Experience of hypnosis in gastrointestinal (GI) endoscopy is scarce in children. Our aims were to assess the rate of successful GI endoscopy performed using hypnosis alone or in combination with midazolam, with or without additional equimolar mixture of oxygen and nitrous oxide (EMONO), and to identify predictive factors of successful endoscopy in children.Methods: This prospective single-centre study included children older than 6 years requiring a diagnostic esophagogastroduodenoscopy (EGD) or rectosigmoidoscopy. Ericksonian hypnosis was performed alone or in combination with midazolam, with or without additional EMONO. Successful endoscopy was defined by a complete and well-tolerated procedure. Levels of satisfaction of the endoscopist, nurse, and patient were assessed.Results: One hundred forty children [70 boys, median age: 12 years (Q1–Q3: 9–14)] were included over a 14-month period. They underwent EGD in 51.4% (n = 72) and rectosigmoidoscopy in 48.6% (n = 68) of cases. EMONO and midazolam were combined with hypnosis in 136 cases (97.1%). Successful endoscopy rate reached 82.9%. The procedure was interrupted due to poor tolerance and was rescheduled under general anaesthesia in 11 patients (7.9%). Predictive factors for successful endoscopy were older age (13 vs. 8 years, OR: 1.34, CI 95% [1.10–1.62], p = 0.003) and type of endoscopy (EGD vs. rectosigmoidoscopy, OR: 16.34 [2.14–124.68], p = 0.007). A good cooperation of the patient was reported by the endoscopist and the nurse in 88.4 and 86.9% of cases, respectively. Ninety-two per cent of patients mentioned that the procedure went well.Conclusions: Our study suggests that hypnosis combined with EMONO and/or midazolam is of additional value to perform diagnostic EGD or rectosigmoidoscopy in children older than 6 years without systematic need for general anaesthesia.