Clin Endosc.  2018 Mar;51(2):142-149. 10.5946/ce.2017.102.

Advanced Therapeutic Gastrointestinal Endoscopy in Children – Today and Tomorrow

• Nabi Z
• Reddy DN

• KMID: 2410980
• DOI: http://doi.org/10.5946/ce.2017.102

Abstract

Gastrointestinal (GI) endoscopy plays an indispensable role in the diagnosis and management of various pediatric GI disorders. While the pace of development of pediatric GI endoscopy has increased over the years, it remains sluggish compared to the advancements in GI endoscopic interventions available in adults. The predominant reasons that explain this observation include lack of formal training courses in advanced pediatric GI interventions, economic constraints in establishing a pediatric endoscopy unit, and unavailability of pediatric-specific devices and accessories. However, the situation is changing and more pediatric GI specialists are now performing complex GI procedures such as endoscopic retrograde cholangiopancreatography and endoscopic ultrasonography for various pancreatico-biliary diseases and more recently, per-oral endoscopic myotomy for achalasia cardia. Endoscopic procedures are associated with reduced morbidity and mortality compared to open surgery for GI disorders. Notable examples include chronic pancreatitis, pancreatic fluid collections, various biliary diseases, and achalasia cardia for which previously open surgery was the treatment modality of choice. A solid body of evidence supports the safety and efficacy of endoscopic management in adults. However, additions continue to be made to literature describing the pediatric population. An important consideration in children includes size of children, which in turn determines the selection of endoscopes and type of sedation that can be used for the procedure.

Keyword

Endoscopy, gastrointestinal; Cholangiopancreatography, endoscopic retrograde; Esophageal achalasia; Pancreatic diseases

MeSH Terms

Adult
Cardia
Child*
Cholangiopancreatography, Endoscopic Retrograde
Diagnosis
Endoscopes
Endoscopy
Endoscopy, Gastrointestinal*
Endosonography
Esophageal Achalasia
Humans
Mortality
Pancreatic Diseases
Pancreatitis, Chronic
Specialization

Figure

• 

  Fig. 1. Endotherapy for chronic pancreatitis in children. (A) Endoscopic retrograde pancreatography (ERP) revealing large intraductal calculi in the pancreatic head (note the limited opacification of the pancreatic duct due to the calculi). (B) ERP image obtained in the same child after undergoing extracorporeal shockwave lithotripsy (note the complete fragmentation of calculi with complete opacification of the pancreatic duct). (C) Placement of a 7 Fr single pigtail plastic stent into the pancreatic duct.

• 

  Fig. 2. Endoscopic ultrasound-guided drainage of walled-off necrosis in a child. (A) Puncture of cystogastric wall using a 21 G fine-needle aspiration needle. (B) Coiling of the guide wire into the cyst cavity. (C) Balloon dilatation of the cystogastric tract. (D) Deployment of novel cystogastric metal stent. (E) Endoscopic view of the cystogastric metal stent. (F) Endoscopic necrosectomy in a child with walled-off necrosis.

• 

  Fig. 3. Per-oral endoscopic myotomy in a child diagnosed with achalasia cardia. (A) Submucosal injection of dye solution to raise a bleb. (B) Mucosal incision over the bleb using a triangle tip knife. (C) Creation of a submucosal tunnel. (D) Coagulation of a vessel using coagulation forceps. (E) Full-thickness myotomy using a triangle tip knife. (F) Closure of the mucosal incision using hemostatic clips.

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