BOOK
Pediatric Endoscopy, An Issue of Gastrointestinal Endoscopy Clinics of North America, E-Book
(2016)
Additional Information
Book Details
Abstract
Over a short few decades, the field of pediatric endoscopy has matured from the exploratory to the routine. Performance of endoscopic procedures in children is now a fundamental aspect of the practice of more than 2000 pediatric gastroenterologists in North America, and endoscopic instruments are increasingly being developed with an eye to their pediatric applications. Ensuring safe and effective endoscopy in children requires specific medical knowledge and technical competency, in addition to appropriately designed equipment and settings. Obtaining consent from parents, as well as assent from patients, for the purposes of performing diagnostic and therapeutic gastrointestinal procedures begins with a deep understanding of risks and benefits that endoscopy affords and is typically gained through formal training in the field. Diagnostic endoscopy may help to confirm common pediatric conditions including eosinophilic esophagitis and inflammatory bowel disease, while therapeutic procedures to treat strictures in the GI tract may help children avoid more invasive surgeries. Using endoscopy in children to achieve hemostasis or to remove commonly swallowed foreign bodies, such as lithium batteries or high-powered magnets, can be lifesaving, and the insertion of feeding tubes can help medically complex patients to thrive. In short, pediatric endoscopy is an integral component of healthcare for children, and gaining and understanding of its best practices may help all clinicians to better recognize its role in pediatric disease outcomes.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Pediatric Endoscopy\r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| CONSULTING EDITOR | iii | ||
| EDITOR | iii | ||
| AUTHORS | iii | ||
| Contents | vii | ||
| Foreword: Pediatric Gastrointestinal Endoscopy: A Mature Subspecialty\r | vii | ||
| Preface: Pediatric Endoscopy\r | vii | ||
| Setting up the Pediatric Endoscopy Unit\r | vii | ||
| Training and Assessment in Pediatric Endoscopy\r | vii | ||
| Informed Consent for Pediatric Endoscopy\r | vii | ||
| Measuring Quality in Pediatric Endoscopy\r | viii | ||
| Management of Upper Gastrointestinal Bleeding in Children: Variceal and Nonvariceal\r | viii | ||
| Lower Gastrointestinal Bleeding in Children\r | viii | ||
| Button Battery Ingestion in Children: A Paradigm for Management of Severe Pediatric Foreign Body Ingestions\r | viii | ||
| Pediatric Considerations in Endoscopic Retrograde Cholangiopancreatography\r | ix | ||
| Role of Endoscopic Ultrasound in Pediatric Disease\r | ix | ||
| Advances in Pediatric Small Bowel Imaging\r | ix | ||
| Advances in Pediatric Gastrostomy Placement\r | ix | ||
| Role of Endoscopy in Diagnosis and Management of Pediatric Eosinophilic Esophagitis\r | x | ||
| Endoscopic Management of Anastomotic Esophageal Strictures Secondary to Esophageal Atresia \r | x | ||
| GASTROINTESTINAL ENDOSCOPY CLINICS\rOF NORTH AMERICA\r | xi | ||
| FORTHCOMING ISSUES | xi | ||
| April 2016 | xi | ||
| July 2016 | xi | ||
| October 2016 | xi | ||
| RECENT ISSUES | xi | ||
| October 2015 | xi | ||
| July 2015 | xi | ||
| April 2015 | xi | ||
| Foreword: Pediatric Gastrointestinal Endoscopy: A Mature Subspecialty \r | xiii | ||
| Preface\r: Pediatric Endoscopy | xv | ||
| Setting up the Pediatric Endoscopy Unit | 1 | ||
| Key points | 1 | ||
| INTRODUCTION | 1 | ||
| UNIT DESIGN | 2 | ||
| GENERAL ENDOSCOPY UNIT AREAS | 3 | ||
| UNIT SIZE AND CAPACITY | 3 | ||
| REPROCESSING | 4 | ||
| STAFFING THE ENDOSCOPY UNIT | 6 | ||
| AFTER-HOURS COVERAGE | 6 | ||
| EQUIPMENT | 9 | ||
| SUMMARY/DISCUSSION | 10 | ||
| REFERENCES | 11 | ||
| Training and Assessment in Pediatric Endoscopy | 13 | ||
| Key points | 13 | ||
| INTRODUCTION | 13 | ||
| TRAINING | 14 | ||
| Endoscopy Skill Acquisition | 14 | ||
| Endoscopy Training Aids | 15 | ||
| Magnetic endoscopic imagers | 15 | ||
| Simulation-based endoscopy training | 15 | ||
| Training the Pediatric Endoscopy Trainer | 17 | ||
| ASSESSMENT | 17 | ||
| Endoscopic Competence | 18 | ||
| Intent of Assessment: Formative Versus Summative | 18 | ||
| Assessment Aims | 20 | ||
| Current State of Assessment of Pediatric Endoscopy | 20 | ||
| Procedural numbers | 21 | ||
| Tools for Assessment | 23 | ||
| Written knowledge tests | 23 | ||
| Simulation-based assessment | 23 | ||
| Quality metrics in pediatric endoscopy | 24 | ||
| Direct observational assessment tools | 25 | ||
| The Gastrointestinal Endoscopy Competency Assessment Tool for pediatric colonoscopy (GiECATKIDS) | 26 | ||
| SUMMARY | 26 | ||
| REFERENCES | 27 | ||
| Informed Consent for Pediatric Endoscopy | 35 | ||
| Key points | 35 | ||
| INTRODUCTION | 35 | ||
| Components of Informed Consent | 36 | ||
| Pediatric Assent | 37 | ||
| Methods of Consent | 37 | ||
| Expertise in the Procedure | 37 | ||
| DIAGNOSTIC ESOPHAGOGASTRODUODENOSCOPY AND COLONOSCOPY | 38 | ||
| Failure to Disclose | 39 | ||
| INFORMED CONSENT FOR PERFORMING THERAPEUTIC GASTROINTESTINAL PROCEDURES IN CHILDREN | 40 | ||
| CONSENT FOR PLACEMENT OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY | 40 | ||
| CONSENT FOR SMALL BOWEL ENTEROSCOPY IN CHILDREN | 42 | ||
| CONSENT FOR PEDIATRIC CAPSULE ENDOSCOPY | 42 | ||
| CONSENT FOR NASAL ENDOSCOPY IN CHILDREN | 42 | ||
| CONSENT FOR PEDIATRIC PH/PH IMPEDANCE/WIRELESS PH MONITORING | 42 | ||
| CONSENT FOR ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CHILDREN | 43 | ||
| SUMMARY | 43 | ||
| REFERENCES | 43 | ||
| Measuring Quality in Pediatric Endoscopy | 47 | ||
| Key points | 47 | ||
| INTRODUCTION | 47 | ||
| MEASURING QUALITY THROUGH PROCEDURAL DOCUMENTATION | 49 | ||
| QUALITY AND ENDOSCOPIC TRAINING | 51 | ||
| QUALITY IMPROVEMENT AND MAINTENANCE OF CERTIFICATION | 52 | ||
| PREPROCEDURE ELEMENTS OF QUALITY PEDIATRIC ENDOSCOPY | 53 | ||
| COMPLICATIONS OF PEDIATRIC ENDOSCOPY | 55 | ||
| INTRAPROCEDURAL ELEMENTS OF QUALITY | 55 | ||
| POSTPROCEDURAL ELEMENTS OF QUALITY | 58 | ||
| SUMMARY | 59 | ||
| REFERENCES | 59 | ||
| Management of Upper Gastrointestinal Bleeding in Children | 63 | ||
| Key points | 63 | ||
| INTRODUCTION | 63 | ||
| CAUSE | 64 | ||
| NEONATES | 64 | ||
| INFANTS/TODDLERS | 65 | ||
| OLDER CHILDREN/ADOLESCENTS | 65 | ||
| EVALUATION | 65 | ||
| INTERVENTIONS | 67 | ||
| ENDOSCOPY | 67 | ||
| NONVARICEAL BLEEDING | 68 | ||
| VARICEAL BLEEDS | 68 | ||
| REBLEEDING | 69 | ||
| OBSCURE BLEEDS | 70 | ||
| SUMMARY AND RECOMMENDATIONS | 70 | ||
| REFERENCES | 71 | ||
| Lower Gastrointestinal Bleeding in Children | 75 | ||
| Key points | 75 | ||
| INTRODUCTION | 75 | ||
| DEFINITIONS | 76 | ||
| EPIDEMIOLOGY | 76 | ||
| CLINICAL PRESENTATION AND COURSE | 77 | ||
| ETIOLOGY | 77 | ||
| Solitary Rectal Ulcer Syndrome | 77 | ||
| Polyps and Postpolypectomy Bleeding | 78 | ||
| Dieulafoy Lesion | 79 | ||
| Angiodysplasias and Other Vascular Anomalies | 80 | ||
| Ileocolonic Ulceration | 81 | ||
| Infectious colitis | 81 | ||
| Inflammatory bowel disease | 81 | ||
| Anastomotic ulceration | 82 | ||
| Graft-versus-host disease | 82 | ||
| Heterotopic gastric mucosa | 82 | ||
| Stercoral ulcer | 82 | ||
| Severe Upper Gastrointestinal Bleeding | 82 | ||
| EVALUATION AND RESUSCITATION | 83 | ||
| DIAGNOSTIC ASSESSMENT | 84 | ||
| Endoscopy | 84 | ||
| Technetium-99 Pertechnetate Disodium Scintigraphy (Meckel Scan) | 84 | ||
| Technetium-99–Labeled Red Blood Cell Scan (Nuclear Bleeding Scan) | 86 | ||
| Angiography: Mesenteric and Radiologic | 86 | ||
| Video Capsule Endoscopy | 87 | ||
| Small Bowel Enteroscopy | 87 | ||
| PREENDOSCOPY PREPARATION AND CONSIDERATIONS | 87 | ||
| ENDOSCOPIC HEMOSTASIS | 88 | ||
| Injection Therapy | 89 | ||
| Epinephrine | 89 | ||
| Ethanol | 90 | ||
| Thermal Devices | 90 | ||
| Heater probe | 90 | ||
| Multipolar/Bipolar probe | 90 | ||
| Argon plasma coagulation | 91 | ||
| Clips | 91 | ||
| Emerging Technologies for Hemostasis in Pediatric Lower Gastrointestinal Bleeding | 92 | ||
| Hemospray | 92 | ||
| Over-the-scope clip | 93 | ||
| SUMMARY | 93 | ||
| REFERENCES | 93 | ||
| Button Battery Ingestion in Children | 99 | ||
| Key points | 99 | ||
| INTRODUCTION | 99 | ||
| BACKGROUND | 100 | ||
| CASE DESCRIPTIONS | 101 | ||
| BUTTON BATTERY INGESTION CASE SERIES | 102 | ||
| Case 1 | 102 | ||
| Lessons Learned | 102 | ||
| Case 2 | 102 | ||
| Lessons Learned | 104 | ||
| Case 3 | 104 | ||
| Pediatric Considerations in Endoscopic Retrograde Cholangiopancreatography | 119 | ||
| Key points | 119 | ||
| OVERVIEW | 119 | ||
| INDICATIONS | 120 | ||
| TECHNICAL CONSIDERATIONS | 125 | ||
| Operating Environment | 125 | ||
| Patient Preparation | 126 | ||
| Sedation | 126 | ||
| Pediatric-Specific Equipment | 127 | ||
| ADVERSE EVENTS | 128 | ||
| Pancreatitis | 129 | ||
| Bleeding, Perforation, and Infection | 130 | ||
| The Future of Pediatric Endoscopic Retrograde Cholangiopancreatography | 132 | ||
| SUMMARY | 132 | ||
| REFERENCES | 133 | ||
| Role of Endoscopic Ultrasound in Pediatric Disease | 137 | ||
| Key points | 137 | ||
| INTRODUCTION | 137 | ||
| Special Technical Considerations | 138 | ||
| INDICATIONS | 138 | ||
| Esophagus | 140 | ||
| Congenital esophageal stenosis | 141 | ||
| Eosinophilic esophagitis and gastroesophageal reflux | 141 | ||
| Gastroesophageal varices and portal hypertension | 142 | ||
| Motility disorders | 142 | ||
| Stomach and Duodenum | 142 | ||
| Duodenal duplication | 142 | ||
| Pyloric stenosis | 142 | ||
| Submucosal and vascular lesions | 143 | ||
| Inflammatory bowel disease | 143 | ||
| Anorectal | 143 | ||
| Pancreaticobiliary | 144 | ||
| Pancreas | 144 | ||
| Biliary tree | 145 | ||
| Pancreatitis | 146 | ||
| Liver | 146 | ||
| THERAPEUTIC ENDOSCOPIC ULTRASOUND | 148 | ||
| Endoscopic Cystgastrostomy | 148 | ||
| Celiac Plexus Neurolysis | 148 | ||
| Endoscopic Ultrasound–Guided Biliary Access | 149 | ||
| Other Therapeutic Indications | 149 | ||
| COMPLICATIONS | 149 | ||
| SUMMARY | 150 | ||
| REFERENCES | 150 | ||
| Advances in Pediatric Small Bowel Imaging | 155 | ||
| Key points | 155 | ||
| INTRODUCTION | 155 | ||
| OVERVIEW OF ENTEROSCOPY | 156 | ||
| ENTEROSCOPY TECHNIQUE | 157 | ||
| PATIENT PREPARATION AND PROCEDURAL SEDATION | 159 | ||
| INDICATIONS | 160 | ||
| Obscure Gastrointestinal Bleeding | 160 | ||
| Inflammatory Bowel Disease/Crohn Disease | 161 | ||
| Polyposis Syndromes | 162 | ||
| Roux-en-Y Altered Anatomy | 163 | ||
| COMPLICATIONS | 163 | ||
| TRAINING AND COMPETENCE | 164 | ||
| SPECIAL CONSIDERATIONS | 165 | ||
| SUMMARY | 165 | ||
| REFERENCES | 165 | ||
| Advances in Pediatric Gastrostomy Placement | 169 | ||
| Key points | 169 | ||
| BACKGROUND | 169 | ||
| PERCUTANEOUS ENDOSCOPIC GASTROSTOMY PROCEDURE | 170 | ||
| Complications of Percutaneous Endoscopic Gastrostomy | 170 | ||
| Risk Factors for Complications of Percutaneous Endoscopic Gastrostomy in Children | 175 | ||
| Exchange and Removal of Percutaneous Endoscopic Gastrostomy | 177 | ||
| Alternative Percutaneous Endoscopic Gastrostomy Techniques | 177 | ||
| LAPAROSCOPIC GASTROSTOMY TUBE PLACEMENT | 178 | ||
| Laparoscopic Techniques | 179 | ||
| Percutaneous Endoscopic Gastrostomy Versus Laparoscopic Technique | 180 | ||
| FUTURE OF GASTROSTOMY PLACEMENT | 180 | ||
| REFERENCES | 182 | ||
| Role of Endoscopy in Diagnosis and Management of Pediatric Eosinophilic Esophagitis | 187 | ||
| Key points | 187 | ||
| INTRODUCTION | 187 | ||
| EOSINOPHILIC ESOPHAGITIS DIAGNOSIS AND SURVEILLANCE | 188 | ||
| Endoscopic Findings | 188 | ||
| Radiology | 188 | ||
| Histology | 189 | ||
| Eosinophilic Esophagitis Treatment | 190 | ||
| Dietary therapy | 191 | ||
| Corticosteroid therapy | 192 | ||
| Eosinophilic Esophagitis Surveillance | 192 | ||
| THERAPEUTIC ROLE OF ENDOSCOPY IN EOSINOPHILIC ESOPHAGITIS | 192 | ||
| Emergent Procedures in Eosinophilic Esophagitis | 192 | ||
| Stricture Management and Dilations | 193 | ||
| Challenges with Eosinophilic Esophagitis Management | 194 | ||
| EMERGING METHODS OF DIAGNOSIS AND TREATMENT | 194 | ||
| Molecular Analysis of Eosinophilic Esophagitis Tissue Samples | 194 | ||
| Endoscopic Ultrasonography | 195 | ||
| EndoFLIP | 195 | ||
| Manometry | 195 | ||
| String Test and Cytosponge | 196 | ||
| Serum Testing | 196 | ||
| SUMMARY | 196 | ||
| REFERENCES | 196 | ||
| Endoscopic Management of Anastomotic Esophageal Strictures Secondary to Esophageal Atresia | 201 | ||
| Key points | 201 | ||
| INTRODUCTION | 201 | ||
| ESOPHAGEAL STRICTURE | 202 | ||
| Pathophysiology and Incidence | 202 | ||
| Esophageal Stricture Symptoms and Definitions | 202 | ||
| ESOPHAGEAL STRICTURE TREATMENT | 204 | ||
| Dilation | 204 | ||
| Mechanical (Bougie) Dilators | 204 | ||
| Balloon Dilation | 205 | ||
| Outcomes and Comparative Data | 206 | ||
| TREATMENT THERAPIES FOR REFRACTORY STRICTURES | 207 | ||
| Intralesional Steroid Injection | 207 | ||
| Mitomycin C | 208 | ||
| Stents | 209 | ||
| Incisional Therapy | 211 | ||
| GENERAL APPROACH TO STRICTURE MANAGEMENT | 213 | ||
| REFERENCES | 214 |