RESUMO
Previous studies have demonstrated the safety of performing endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric population; however, few have addressed the outcomes of children undergoing ERCP during acute pancreatitis (AP). We hypothesize that ERCP performed in the setting of AP can be executed with similar technical success and adverse event profiles to those in pediatric patients without pancreatitis. Using the Pediatric ERCP Database Initiative, a multi-national and multi-institutional prospectively collected dataset, we analyzed 1124 ERCPs. One hundred and ninety-four (17%) of these procedures were performed in the setting of AP. There were no difference in the procedure success rate, procedure time, cannulation time, fluoroscopy time, or American Society of Anesthesiology class despite patients with AP having higher American Society of Gastrointestinal Endoscopy grading difficulty scores. This study suggests that ERCP can be safely and efficiently performed in pediatric patients with AP when appropriately indicated.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Pancreatite , Criança , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatite/diagnóstico por imagem , Pancreatite/cirurgia , Pancreatite/epidemiologia , Doença Aguda , Estudos Retrospectivos , FluoroscopiaRESUMO
This study examines the role of trainee involvement with pediatric endoscopic retrograde cholangiopancreatography (ERCP) and whether it affects the procedure's success, post-procedural adverse outcomes, and duration. A secondary analysis of the Pediatric ERCP Database Initiative, an international database, was performed. Consecutive ERCPs on children <19 years of age from 18 centers were entered prospectively into the database. In total 1124 ERCPs were entered into the database, of which 320 (28%) were performed by trainees. The results showed that the presence of trainees did not impact technical success ( P = 0.65) or adverse events rates ( P = 0.43). Rates of post-ERCP pancreatitis, pain, and bleeding were similar between groups ( P > 0.05). Fewer cases involving trainees were in the top quartile (>58 minutes) of procedural time (19% vs 26%; P = 0.02). Overall, our findings indicate trainee involvement in pediatric ERCP is safe.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Pancreatite , Criança , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pancreatite/epidemiologia , Pancreatite/etiologia , Estudos RetrospectivosRESUMO
OBJECTIVES: Endoscopic retrograde cholangiopancreatography (ERCP) in adults has been extensively studied through multicenter prospective studies. Similar pediatric studies are lacking. The Pediatric ERCP Database Initiative (PEDI) is a multicenter collaborative aiming to evaluate the indications and technical outcomes in pediatric ERCPs. METHODS: In this prospective cohort study, data were recorded for pediatric ERCPs performed across 15 centers. A pre-procedure, procedure, 2-week post-procedure follow-up, and adverse event form were completed for each ERCP performed. Univariate and stepwise linear regression was performed to identify factors associated with technically successful procedures and adverse events. RESULTS: A total of 1124 ERCPs were performed on 857 patients from May 1, 2014 to May 1, 2018. The median age was 13.5 years [interquartile range (IQR) 9.0-15.7]. Procedures were technically successful in the majority of cases (90.5%) with success more commonly encountered for procedures with biliary indications [odds ratio (OR) 4.2] and less commonly encountered for native papilla anatomy (OR 0.4) and in children <3 years (OR 0.3). Cannulation was more often successful with biliary cannulation (95.9%) compared to pancreatic cannulation via the major papilla (89.6%, P < 0.0001) or minor papilla (71.2%, P < 0.0005). The most commonly identified adverse events included post-ERCP pancreatitis (5%), pain not related to post-ERCP pancreatitis (1.8%), and bleeding (1.2%). Risk factors for the development of each were identified. CONCLUSIONS: This large prospective study demonstrates that ERCP is reliable and safe in the pediatric population. It highlights the utility of PEDI in evaluating the technical outcomes of pediatric ERCPs and demonstrates the potential of PEDI for future studies in pediatric ERCPs.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Pancreatite , Humanos , Criança , Adulto , Adolescente , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Estudos Prospectivos , Estudos Retrospectivos , Cateterismo/efeitos adversos , Pancreatite/etiologiaRESUMO
BACKGROUND AND AIMS: Ionizing radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) is an important quality issue especially in children. We aim to identify factors associated with extended fluoroscopy time (FT) in children undergoing ERCP. METHODS: ERCP on children <18âyears from 15 centers were entered prospectively into a REDCap database from May 2014 until May 2018. Data were retrospectively evaluated for outcome and quality measures. A univariate and step-wise linear regression analysis was performed to identify factors associated with increased FT. RESULTS: 1073 ERCPs performed in 816 unique patients met inclusion criteria. Median age was 12.2âyears (interquartile range [IQR] 9.3-15.8). 767 (71%) patients had native papillae. The median FT was 120âseconds (IQR 60-240). Factors associated with increased FT included procedures performed on patients with chronic pancreatitis, ERCPs with American Society of Gastrointestinal Endoscopy (ASGE) difficulty grade >3, ERCPs performed by pediatric gastroenterologist (GI) with adult GI supervision, and ERCPs performed at non-free standing children's hospitals. Hispanic ethnicity was the only factor associated with lower FT. CONCLUSION: Several factors were associated with prolonged FTs in pediatric ERCP that differed from adult studies. This underscores that adult quality indicators cannot always be translated to pediatric patients. This data can better identify children with higher risk for radiation exposure and improve quality outcomes during pediatric ERCP.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Exposição à Radiação , Adulto , Criança , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Estudos de Coortes , Fluoroscopia/efeitos adversos , Humanos , Exposição à Radiação/efeitos adversos , Estudos RetrospectivosRESUMO
BACKGROUND: Post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) is reported to occur in up to 11% of pediatric patients. To date, no study has prospectively evaluated an intervention to prevent PEP in children. It is unclear if such a study is even feasible. OBJECTIVE: The aim of the study was to evaluate the feasibility of studying IV ibuprofen for PEP prevention in the pediatric population. METHODS: This was a prospective randomized double-blind placebo-controlled feasibility study. Patients younger than 19 years of age undergoing ERCP were randomized to receive 10âmg/kg IV ibuprofen (max of 800âmg) or placebo (saline) at the time of ERCP. The primary outcome was PEP. Secondary outcomes included post-ERCP-related bleeding, rates of other procedural and medication-related adverse events. RESULTS: Fifty-eight patients were randomized and received either IV ibuprofen or placebo. Preprocedure- and procedure-related factors were not significantly different between the groups except that patients in the placebo group tended to weigh less (48.7 vs 63.7âkg, Pâ=â0.03). There were 7 episodes of PEP (12%). PEP was less frequently identified in the Ibuprofen group than in the control group (7% vs 17%), but this was not statistically significant (Pâ=â0.42). Mean postprocedural abdominal pain scores were significantly lower in the IV Ibuprofen group than in the control group (1.1 vs 3.1, Pâ=â0.01) and the number of patients who had increased abdominal pain after the procedure was significantly lower in ibuprofen group than in the control group (3% vs 38%, Pâ=â0.002). There were no significant differences in procedure-related or drug-related adverse events. CONCLUSIONS: Postprocedural pain scores and the number of patients who had increased abdominal pain after the procedure were significantly lower in the IV ibuprofen group. The current study provides encouraging, but only very weak evidence that IV ibuprofen decreases PEP in children. Power analysis suggests that a small handful of high-volume pediatric centers would be able to perform an adequate clinical trial in a reasonable time frame. Focusing on all cause postprocedural pain (PEP and non-PEP) may allow for a more efficiency study design and be just as clinically relevant.
Assuntos
Dor Abdominal/prevenção & controle , Anti-Inflamatórios não Esteroides/administração & dosagem , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ibuprofeno/administração & dosagem , Dor Pós-Operatória/prevenção & controle , Pancreatite/prevenção & controle , Dor Abdominal/etiologia , Administração Intravenosa , Adolescente , Criança , Método Duplo-Cego , Estudos de Viabilidade , Feminino , Humanos , Masculino , Dor Pós-Operatória/etiologia , Pancreatite/etiologia , Estudos Prospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: Children with choledocholithiasis are frequently managed at tertiary children's hospitals that do not have available endoscopic retrograde cholangiopancreatography (ERCP) proceduralists. We hypothesized that patients treated at hospitals without ERCP proceduralists would have a longer hospital length of stay (LOS) than those with ERCP proceduralists. METHODS: Charts were reviewed for patients who underwent cholecystectomy and ERCP at 3 tertiary children's hospitals over 10 years. Trauma and complicated pancreatitis patients were excluded. Comparisons between patients requiring and not requiring transfer for ERCP were made using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables. RESULTS: One hundred and sixty-four children underwent ERCP for suspected choledocholithiasis: 79 (48%) in the transfer group and 85 (52%) in the no transfer group.Median LOS was longer for patients requiring transfer (7 vs 5 days, Pâ<â0.0001). One-third (34%) of the transfer patients had magnetic resonance cholangiopancreatography compared to only 7% that did not require transfer (Pâ<â0.0001). Among the 123 patients who underwent ERCP before cholecystectomy, 53% required (66/123) transfer and 47% (57/123) did not. Transfer group patients had longer median hospital LOS (Pâ<â0.0001), more days between admission and ERCP (Pâ<â0.0001), and more days between ERCP and surgery (Pâ=â0.0004). CONCLUSIONS: Overall median LOS was significantly shorter for patients who underwent ERCP at the admitting facility. Patients who underwent ERCP before cholecystectomy at hospitals without available ERCP proceduralists incurred longer LOS. There is a need for more pediatric proceduralists appropriately trained to perform ERCP in children.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colecistectomia/estatística & dados numéricos , Coledocolitíase/cirurgia , Hospitais Pediátricos/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Adolescente , Criança , Colecistectomia/métodos , Feminino , Humanos , MasculinoRESUMO
OBJECTIVE: There is little published experience with the use of over-the-scope clips (OTSCs) in pediatric patients. The aim of this study is to present our single-center experience utilizing OTSCs for nonvariceal gastrointestinal (GI) bleeding. METHODS: This is a retrospective case series of pediatric patients who underwent endoscopic management of GI bleeding during which OTSCs were used. RESULTS: Eleven cases of OTSC utilization for hemostasis were identified in 10 unique patients between November 2014 and May 2016. The median age at intervention was 14.7 years (range 3.9-16.8 years) and median weight was 39âkg (range 17.4-85.8âkg). Technical success and hemostasis were achieved in all cases and there were no complications. Median follow-up was 32.9 months (range 21.2-39.4 months). All nonanastomotic ulcers (4), polypectomy bleeding (2), and sphincterotomy bleeding (1) had no evidence of recurrent GI bleeding at last follow-up. Two patients with anastomotic ulcerations required additional medical interventions. CONCLUSIONS: Our series demonstrates the safety and effectiveness of the OTSCs in the pediatric population for acute GI bleeding throughout the GI tract. In our experience, it is effective for nonanastomotic ulcers, postpolypectomy bleeding, and postsphincterotomy bleeding even when other hemostatic techniques have failed. OTSCs may be less effective in the setting of anastomotic ulcerations, reaffirming the refractory nature of these lesions.
Assuntos
Endoscopia Gastrointestinal/instrumentação , Gastroenteropatias/complicações , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/instrumentação , Instrumentos Cirúrgicos , Adolescente , Criança , Pré-Escolar , Endoscopia Gastrointestinal/métodos , Feminino , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica/métodos , Humanos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Risk factors for the development of post-ERCP pancreatitis (PEP) have not been identified in the pediatric population. It remains unclear what constitutes appropriate prophylaxis in this patient population. OBJECTIVES: To assess the prevalence and severity of PEP in the pediatric population and identify factors associated with developing PEP and to evaluate the effect of prophylactic pancreatic duct stenting in high-risk patients. DESIGN: Retrospective analysis of an ERCP database at a single large pediatric center. SETTING: Academic center. PATIENTS: A total of 432 ERCPs performed on 313 patients younger than 19 years of age from January 2004 to October 2013. INTERVENTION: ERCP for any indication. MAIN OUTCOME MEASUREMENTS: Rates and severity of PEP, preprocedural and procedural risk factors for the development of PEP, and the effect of pancreatic stents on preventing PEP in high-risk patients. RESULTS: PEP occurred after 47 procedures (prevalence, 10.9%). Thirty-four cases were mild, 9 were moderate, and 4 were severe. There was no mortality. On multiple logistic analysis, pancreatic duct injection (P<.0001; odds ratio 30.8; 95% confidence interval [CI], 9.1-103.9) and pancreatic sphincterotomy (P<.01; OR 3.8; 95% CI, 1.6-9.8) were positively associated with PEP. A history of chronic pancreatitis was negatively associated with PEP (P<.05; OR 0.37; 95% CI, 0.15-0.93). On subset analysis, placing a prophylactic pancreatic stent was associated with significantly increased rates of PEP in patients with pancreatic duct injection compared with those who had no attempt at stent placement (P<.01). Two patients with severe pancreatitis had prophylactic pancreatic stents in place. LIMITATIONS: Retrospective investigation. CONCLUSIONS: In the pediatric population, pancreatic duct injection and pancreatic sphincterotomy are associated with significantly increased rates of PEP, whereas a history of chronic pancreatitis is negatively associated. Prophylactic pancreatic stenting is associated with higher rates of PEP in high-risk patients and does not eliminate severe PEP.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Ductos Pancreáticos/cirurgia , Pancreatite/etiologia , Stents/efeitos adversos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Razão de Chances , Pâncreas/patologia , Pancreatite/epidemiologia , Pancreatite/prevenção & controle , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
Multiple endoscopic methods are available to treat symptomatic internal hemorrhoids. Because of its low cost, ease of use, low rate of adverse events, and relative effectiveness, RBL is currently the most widely used technique.
Assuntos
Hemorroidas/terapia , Fotocoagulação a Laser/instrumentação , Proctoscópios , Escleroterapia/instrumentação , Criocirurgia/instrumentação , Diatermia/instrumentação , Eletrocoagulação/instrumentação , Humanos , Raios Infravermelhos/uso terapêutico , Ligadura/instrumentaçãoRESUMO
We investigated the volume of endoscopic retrograde cholangiopancreatographies (ERCPs) performed in hospitalized children in the United States using a nationwide healthcare administrative database for the years 2000 to 2009. A total of 22,153 cases of ERCP were identified: 6372 diagnostic and 17,314 therapeutic (1533 cases were recorded as undergoing both types during a single hospitalization). The number of ERCPs increased from 5337 to 6733 per year; diagnostic ERCPs decreased 43% and therapeutic increased 69% (significant decreasing trends for diagnostic and increasing for therapeutic ERCPs, P<0.001 for each analysis). Our results define a recent increase in the use of therapeutic ERCPs in hospitalized children.
Assuntos
Doenças Biliares/diagnóstico , Doenças Biliares/terapia , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Colangiopancreatografia Retrógrada Endoscópica/tendências , Pancreatite/diagnóstico , Pancreatite/terapia , Adolescente , Negro ou Afro-Americano/estatística & dados numéricos , Doenças Biliares/epidemiologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Hispânico ou Latino/estatística & dados numéricos , Hospitalização , Humanos , Lactente , Classificação Internacional de Doenças , Masculino , Pancreatite/epidemiologia , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
Over the last decade, WCE has established itself as a valuable test for imaging the small intestine. It is a safe and relatively easy procedure to perform that can provide valuable information in the diagnosis of small-bowel conditions. Its applications still remain limited within the esophagus and colon. Future developments may include improving visualization within the esophagus and developing technologies that may allow manipulation of the capsule within the GI tract and biopsy capabilities.
Assuntos
Cápsulas Endoscópicas , Endoscopia por Cápsula , Gastroenteropatias/diagnóstico , Pólipos Intestinais/diagnóstico , Endoscopia por Cápsula/efeitos adversos , Endoscopia por Cápsula/instrumentação , Doença Celíaca/diagnóstico , Colo , Doença de Crohn/diagnóstico , Doenças do Esôfago/diagnóstico , Esôfago , Gastroenteropatias/complicações , Hemorragia Gastrointestinal/etiologia , Humanos , Neoplasias Intestinais/diagnóstico , Intestino DelgadoRESUMO
Biliary and pancreatic stents are used in a variety of benign and malignant conditions including strictures and leaks and in the prevention of post-ERCP pancreatitis.Both plastic and metal stents are safe, effective, and easy to use. SEMSs have traditionally been used for inoperable malignant disease. Covered SEMSs are now being evaluated for use in benign disease. Increasing the duration of patency of both plastic and metal stents remains an important area for future research.
Assuntos
Doenças Biliares/cirurgia , Pancreatopatias/cirurgia , Stents , Colangiopancreatografia Retrógrada Endoscópica , Desenho de Equipamento , Humanos , Metais , Plásticos , Stents/efeitos adversos , Stents/economiaRESUMO
OBJECTIVE: The aim of this study was to demonstrate that an appropriately trained pediatric gastroenterologist can perform endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis both safely and effectively. METHODS: Retrospective analysis of ERCP experience from November 2006 to May 2012. Only ERCPs performed by a pediatric gastroenterologist on pediatric patients for the indication of suspected choledocholithiasis were included for formal chart review. Patient characteristics, procedural success, and adverse events were recorded, and subsequently compared with quality standards as defined by the American Society for Gastrointestinal Endoscopy Quality Task Force. RESULTS: A total of 154 ERCPs were performed, of which 65 (42%) were performed on unique patients for the indication of suspected choledocholithiasis. The median age was 15.2 years (range 1 month-18.4 years). The median weight was 65 kg (range 4-127 kg). Biliary cannulation was achieved in 65 (100%). All 65 patients underwent sphincterotomy. Ductal clearance was achieved in 64 (98%) patients during the initial ERCP session. Adverse events included 3 (5%) episodes of mild pancreatitis, 1 episode of moderate bleeding, and 1 episode of sphincterotomy clot causing obstruction and need for repeat ERCP within 1 week. Overall, 5 (8%) unique patients experienced a complication. CONCLUSIONS: Therapeutic ERCP for the indication of choledocholithiasis can be performed by an appropriately trained pediatric gastroenterologist at a pediatric facility with acceptable cannulation rates, stone extraction rates, and adverse event rates as defined by the American Society for Gastrointestinal Endoscopy Quality Task Force.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Coledocolitíase/cirurgia , Competência Clínica , Gastroenterologia , Pâncreas/lesões , Pediatria , Complicações Pós-Operatórias/prevenção & controle , Centros Médicos Acadêmicos , Adolescente , Criança , Pré-Escolar , Coledocolitíase/diagnóstico por imagem , Hospitais Pediátricos , Humanos , Lactente , Auditoria Médica , Pâncreas/imunologia , Pancreatite/epidemiologia , Pancreatite/etiologia , Pancreatite/fisiopatologia , Pancreatite/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Radiologia Intervencionista , Estudos Retrospectivos , Índice de Gravidade de Doença , Texas/epidemiologia , Recursos HumanosRESUMO
The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of new or emerging endoscopic technologies that have the potential to have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent preclinical and clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. For this review, the MEDLINE database was searched through January 2011 using the keywords "bariatric," "endoscopic," "intragastric balloon," "duodenojejunal bypass sleeve," and "transoral gastroplasty." Reports on Emerging Technologies are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. These reports are scientific reviews provided solely for educational and informational purposes. Reports on Emerging Technologies are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
Assuntos
Endoscopia Gastrointestinal/métodos , Balão Gástrico , Obesidade/terapia , Próteses e Implantes , Toxinas Botulínicas/uso terapêutico , Endoscopia Gastrointestinal/instrumentação , Humanos , Neurotoxinas/uso terapêuticoRESUMO
The ASGE Technology Committee provides reviews of existing, new, or emerging endoscopic technologies that have an impact on the practice of GI endoscopy. Evidence-based methodology is used, performing a MEDLINE literature search to identify pertinent clinical studies on the topic and a MAUDE (U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized, but in many cases data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. Technology Status Evaluation Reports are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the Committee as a whole, and approved by the Governing Board of the ASGE. When financial guidance is indicated, the most recent coding data and list prices at the time of publication are provided. For this review, the MEDLINE database was searched through September 2010 for articles related to endoscopy by using the key words "gastroscope," "colonoscope," "echoendoscope," "duodenoscope," "choledochoscope," "ultraslim endoscope," "variable stiffness colonoscope," and "wide-angle colonoscope." Technology Status Evaluation Reports are scientific reviews provided solely for educational and informational purposes. Technology Status Evaluation Reports are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.
Assuntos
Endoscópios Gastrointestinais , Endoscopia Gastrointestinal/instrumentação , Endoscópios Gastrointestinais/economia , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , SegurançaRESUMO
PURPOSE OF REVIEW: Endoscopic investigation of small bowel disorders in children has historically been difficult due to the length and tortuosity of the organ itself. New technology introduced over the past decade allows minimally invasive, detailed endoscopic evaluation of the small bowel mucosa from the duodenum to the cecum. While understudied in the pediatric population, literature is emerging supporting the use of these techniques and devices in children. RECENT FINDINGS: Well tolerated and clinically useful capsule endoscopy has been reported a number of times in children, and the indications and potential complications of this procedure are discussed. The limitations of capsule endoscopy, namely inability to biopsy and treat small bowel lesions, have been addressed to some extent by the introduction of balloon enteroscopy, which allows deep intubation of the small bowel, and at times viewing of the entire mucosal surface. Balloon enteroscopy has been safely reported in children as small as 13.1 âkg, and has been successfully performed in children with Roux-en-Y anastomoses in the evaluation and therapy of biliary strictures. SUMMARY: New enteroscopic techniques now allow detailed investigation and therapy of small bowel lesions in a minimally invasive fashion in the pediatric population.
Assuntos
Endoscopia Gastrointestinal/métodos , Enteropatias/diagnóstico , Intestino Delgado/patologia , Biópsia , Endoscopia por Cápsula , Criança , Enteroscopia de Duplo Balão , Endoscopia Gastrointestinal/instrumentação , Humanos , Enteropatias/cirurgia , Intestino Delgado/cirurgiaRESUMO
BACKGROUND: While pancreatitis is uncommon in children, pseudocyst development can be a serious complication. Endoscopic drainage of pseudocysts is well established in adults. However, there are limited data regarding this procedure in a pediatric population. The objective of this study is to determine the safety and efficacy of endoscopic ultrasound-guided pseudocyst drainage in children. METHODS: The study group included children (age <18 years) who presented for endoscopic drainage of symptomatic pancreatic pseudocysts in whom endoscopic ultrasound (EUS) was performed. In those cases with EUS guidance, a 19-gauge needle was used to access the pseudocyst and place a guidewire under fluoroscopic visualization. Needle-knife diathermy and balloon dilation of the tract were performed with subsequent placement of double pig-tailed stents for drainage. RESULTS: Ten children with mean age of 11.8 years (range 4-17 years) were analyzed for pancreatic pseudocysts due to biliary pancreatitis (n = 4), trauma (n = 2), familial pancreatitis (n = 1), idiopathic pancreatitis (n = 2), and pancreas divisum (n = 1). In eight cases, EUS-guided puncture and stent placement was successful. In the remaining two cases, aspiration of cyst fluid until complete collapse was adequate. As experience increased with EUS examination in children, the therapeutic EUS scope alone was used in 50% of cases for the entire procedure. In all ten cases, successful transgastric endoscopic drainage of pseudocysts was achieved. CONCLUSIONS: Endoscopic drainage of symptomatic pancreatic pseudocysts can be achieved safely in children. EUS guidance facilitates optimal site of puncture as well as placement of transmural stents.
Assuntos
Drenagem/métodos , Endoscopia do Sistema Digestório/métodos , Pseudocisto Pancreático/cirurgia , Adolescente , Criança , Pré-Escolar , Endossonografia/instrumentação , Feminino , Fluoroscopia/instrumentação , Humanos , Masculino , Pseudocisto Pancreático/diagnóstico por imagem , Pancreatite/diagnóstico por imagem , Pancreatite/cirurgia , Stents , Resultado do TratamentoRESUMO
Single-balloon enteroscopy (SBE) allows deep endoscopic access to the jejunum and ileum in adults; however, there are no published series describing the safety of, and indications for, SBE in a pediatric population.Seven pediatric patients (5-17 years) underwent SBE in a 9-month period. Five of 7 procedures achieved the goal. There were no serious complications, and SBE positively affected patient management in 5 of 7 cases.We conclude that SBE is feasible in a pediatric population and can positively affect patient care.