Pediatric Gastroscope Research Articles

Percutaneous Transrenal Electro-Incision of Ureterointestinal Anastomotic Strictures: Long-Term Results and Comparison of Fluoroscopic and Endoscopic Guidance

Purpose We determined the long-term outcome of a new technique for incising ureterointestinal anastomotic strictures using a transrenal percutaneously inserted papillotome. Procedures using fluoroscopic and endoscopic guidance were compared. Materials and Methods Of 33 stenoses incised in 30 patients 15 were in ileal conduit diversions and 15 were in enterocystoplasties. The papillotome was inserted percutaneously over a guide wire into the stenosis, and then deflected and gently withdrawn under fluoroscopic (11 cases) or endoscopic (22) guidance using a flexible pediatric gastroscope or a lateral duodenoscope inserted retrograde into the ileal loop or neobladder. Air filling provided an excellent view of the stenotic area. Operative time did not exceed 45 minutes. The only major complication was damage to a right internal iliac artery. Results Followup data were available for 31 stenoses, with 27 followed for longer than 12 months after stent removal. Of the stenoses 22 are completely patent (actuarial long-term patency rate 71 percent), 3 showed partial improvement and 6 recurred requiring further treatment. Conclusions Combined endoscopic and fluoroscopic guidance is preferable to fluoroscopy alone. The technique is simple if the endoscope is inserted retrograde. Long-term results are satisfactory and we believe that incision should be the initial approach to strictures of uro-digestive anastomoses.

Transgastric Esophagoscopy with Antegrade Dilation

An 80-year-old man in whom successful dilation of an obstructed esophagus via retrograde esophagoscopy was carried out is reported here. His nutrition had been previously sustained by a feeding gastrostomy tube inserted under radiologic guidance. This gastrostomy stoma was dilated to allow passage of a pediatric gastroscope into the stomach and esophagus. A guide wire was then negotiated past the esophageal stricture, under endoscopic vision and fluoroscopic guidance, into the oropharynx. Savary dilators were then passed over the guide wire perorally to dilate the stenosis. The patient was able to swallow liquids soon after the procedure. The use of Savary dilators over a guide wire introduced by retrograde esophagoscopy has not been previously described.

Pediatric total colonoscopy.

One hundred fifty-one total colonoscopies were performed in 105 children ranging from 1 month to 15 years of age. The cecum was reached successfully in 136 examinations without complications, generally within 30 minutes. Our major indications for total colonoscopy were abnormal findings in a contrast enema, undiagnosed rectal bleeding, and possible organic lesion causing intussusception. All procedures were performed using sedation only. The pediatric gastroscope was employed for total colonoscopy on infants less than 6 years of age; the cecum was reached successfully in 98 of 106 procedures with this instrument. Our total colonoscopy series contributed to the diagnosis of various disorders in 86 children and of normality in the 19 remaining children. The results suggest that, if performed with proper precautions and techniques, total colonoscopy is a safe and useful procedure with which to examine the entire colon of infants and children.

Protection against the staphylococcal enterotoxin-induced intestinal disorder in the monkey by anti-idiotypic antibodies.

The staphylococcal enterotoxin serotype B (SEB)-induced enteric intoxication and the immediate-type reaction in the skin of unsensitized monkeys was used to define whether agents competing with SEB for target cell receptors may inhibit pathophysiological effects. For this purpose a duodenal provocation test was developed by use of a pediatric gastroscope, allowing the evaluation of the influence of antagonists on the intestinal disorder upon SEB challenge at the same duodenal site. First, carboxymethylation of histidine residues of SEB caused a complete loss of emetic and skin-sensitizing activity without changing the immunological specificity. However, carboxymethylated SEB is a strong inhibitor of enteric intoxications and immediate-type skin reactions upon SEB challenge. Second, after immunization of BALB/c mice with monoclonal anti-SEB antibodies, monoclonal antiidiotypic antibodies (anti-Id) were obtained by the "hybridoma technique" and purification by idiotype-affinity chromatography. Anti-Id specifically inhibited the binding of horseradish peroxidase-labeled anti-SEB to the ligand, and SEB blocked as well the interaction of these two antibody species, indicating a high degree of binding-site selectivity. Anti-Id completely protected against emetic response and diarrhea upon duodenal provocation with SEB and inhibited immediate-type skin reactions as well. Further, anti-Id acted as an antagonist without triggering biologic functions themselves. This shows that anti-Id constitute a useful tool to protect against a bacterial toxin-induced intestinal disorder.

Primary malignant melanoma of the esophagus

An 81-year-old white man first developed dysphagia, primarily for solid food, in August 1981. He had lost approximately 7 pounds during the previous year. He offered no complaints of chest or abdominal pain. In November 1981, physical examination revealed a cachectic, elderly man in no acute distress. The fundi were unremarkable. The liver was not enlarged, and no skin lesions were identified. The stool was Hemoccult negative. All routine laboratory testing was normal with the exception of a slightly low hemoglobin and hematocrit (13.5 gjdl and 40.7%, respectively). The liver function tests were normal. An upper gastrointestinal series (Fig. 1) revealed a large, irregular, polypoid lesion of the middle third of the esophagus. Prominent rugae were seen along the greater curvature of the gastric fundus. Endoscopy was performed with the Olympus GIF-Q and GIF-P2 endoscopes. A large, brown-black, multilobulated, polypoid mass arose at the midesophagus and ended near the esophagogastric junction (Fig. 2). The mass had focal superficial ulcerations and was quite friable. It almost completely occluded the esophageal lumen, and the pediatric gastroscope was used to pass the obstructing mass. Endoscopic examination of the stomach and duodenum was normal. Biopsy of the mass was characteristic of melanoma of the esophagus (Fig. 3). After detailed consultation with the patient, he refused all therapeutic modalities. He became progressively more cachectic and died in May 1983, 21 months after the diagnosis was made.

A new technique for flexible endoscopic foreign body removal in infants

Most foreign bodies may be extracted from the gastrointestinal tract with flexible fiber-optic endoscopes. Endoscopic overtubes (flexible conduits inserted over the fiberoptic endoscope) permit safe extraction of sharp or pointed objects. We report a technique of foreign body removal for use in infants and small children in whom a standard pediatric gastroscope and overtube is too large.

Perforation of ileal conduit with pediatric gastroscope during endoscopy

We report a case of perforation of ileal conduit during endoscopy, a rare complication of a procedure done infrequently in most institutions. We present one method of treatment.

Clinical evaluation of the fiberoptic bronchoscope (Olympus BF 5B) for pediatric endoscopy

N DECEMBER 1970, the Liverpool Regional Hospital Board made money available for the purchase of a pediatric gastroscope. This report is based on the clinical experience gained using the Olympus (BF 5B) fiberoptic bronchoscope as a pediatric gastroscope on 41 patients. At present there is no instrument specifically designed as a pediatric gastroscope. Various manufacturers who were approached stated that such an instrument might become available when the backlog of orders for instruments for the various endoscopic units had been completed. The need for pediatric gastroscopy and endoscopy is obvious. The indications for endoscopic examination are different in children than in adults. In most cases, the need is for examination only and biopsy is seldom necessary. Photography, both still and cine, is a desirable extra. The age range of children requiring investigation starts from the neonatal period. The size of the esophagus in a full-term neonate is 9-10 cm in length and 4-6 mm in diameter. The growth in size of the trachea in infants is well known and is related to the age rather than the weight of the child. To determine the size of the required endotracheal tube, anesthetists use a guide based on the age of the child. 1 No such formula is available for judging the size of instrument to be passed clown an infant's esophagus. A 10-mm rigid esophagoscope can be passed easily into the esophagus of a neonate. An adult 13-mm gastroscope can be passed easily in a 7-yr-old patient. Various instruments were inspected and the 5-mm bronchoscope (Olympus BF 5B) was selected with the specifications shown in Table 1. Three deficiencies soon became apparent: the inadequate working length of the instrument, especially in older children; the short depth of focus, preventing a sharp image of objects further than 45 mm away from the tip; and poor-quality photographs of certain areas. Cine photography was unsuccessful with the standard compact light source (CLS).