Endoscopy Procedure in Infant and Children

What is endoscopy?

Endoscopy is the process used to diagnose and treat various gastrointestinal diseases. During endoscopy, the gastroenterologists insert a tube, with light and camera at the tip, to view GIT. When the tube is inserted thorough mouth, the process is known as upper endoscopy and when inserted from the rectum, the process is known as lower endoscopy or colonoscopy.

How endoscopy procedures in infants and children differ from endoscopy procedures in adults?

The endoscopy procedure in children and infants requires more expertise. The gastroenterologists performing such endoscopy should manage anxiety in children during the procedure. The gastroenterologists should have undergone training in pediatric endoscopy and have the experience of treating gastrointestinal tract disorders in children and infants.

What are the various endoscopic procedures in children and infants?

Following are the various procedures performed through endoscopy:

Oesophagus-gastro-duodenoscopy (EGD): EGD is an upper endoscopy procedure. In this procedure, the gastroenterologist will insert a tube with a camera at the tip, known as endoscope, into the mouth. The tube moves into the oesophagus, stomach and proximal part of the small intestine. EGD is used to diagnose various conditions such as celiac disease, inflammatory bowel disease, GERD, and ulcers. EGD also diagnoses the diseases, such as eosinophilic esophagitis, through biopsy. EGD has also found its place in a therapeutic outcome such as removal of foreign bodies, treating oesophageal strictures, and endoluminal gastroplication for treating GERD in children.

Capsule endoscopy: Capsule endoscopy plays a vital role in viewing those areas which are not possible through upper and lower endoscopies. Depending upon the age of children undergoing capsule endoscopy, the capsule is either placed through endoscopy or swallowed. Diseases diagnosed through capsule endoscopy include Crohn’s disease, unexplained GI bleeding, and tumours. As it does not use radiations, anaesthesia or sedation, it is of particular importance in children.

BRAVO pH Test: This test is done in children above 4 years of age. In this test, a capsule is attached to the oesophagus of a child which monitors the pH level for 48 hours. This test helps in the diagnosis of GERD.

Colonoscopy: During a colonoscopy, the gastroenterologist will insert an endoscope from the rectum to the large and small intestine. Therapeutic and diagnostic colonoscopy can be done in both infants and children. Colonoscopy is done to diagnose inflammatory bowel disease, polyposis syndrome, juvenile polyps, allergic colitis, and infective colitis. 

Ligations: Also known as endoscopy band ligation, this procedure is done to prevent bleeding from the oesophagus. A surgical thread is tied which prevents further bleeding. In children with portal hypertension, abnormal blood vessels develop in the oesophagus that may cause bleeding. 

Double Balloon Enteroscopy: Double balloon enteroscopy is the procedure that involves the insertion of a long tube with the camera along with plastic overtube to diagnose and treat the diseases in the small intestine. It is an invasive method and is used in children with high suspicion of pathologies involving the small intestine.

Polypectomy: Polypectomy is the procedure done to remove polyps. The polyps may be removed through EGD, double-balloon enteroscopy or colonoscopy. 

Removal of foreign bodies: Objects which are harmful and remains in GIT are removed through endoscopy. It avoids the risk of damage to GIT as well as its obstruction. 

Stop Bleeding: In cases where the medications fail to prevent bleeding in the intestine of infants and children, endoscopy comes to rescue.  

Dilatation: Dilatation is the process of widening that area in the intestine which is narrowed. The narrowing of the intestine may be due to eosinophilic esophagitis and inflammatory bowel disease.

What are the various considerations in endoscopy?

Consideration Details
Patient preparation Sufficient information regarding the procedure and associated risks will be communicated to the parents of infants and children.
Evaluation before the procedure A comprehensive evaluation, especially the loose tooth and tonsil inflammation, should be done to prevent any complication during the procedure.
Restrictions on diet The patient should stop eating or drinking the night before the procedure. However, it depends upon the procedure to be conducted.
Initiation of Medications Certain medications such as antibiotics are administered to the patient before the procedure to reduce the risk of infection.
Sedation Proper sedation procedure i.e. moderate or deep sedation should be performed depending upon the age of patients as well as the procedure to be conducted. Improper sedation may result in respiratory complications.

In which conditions endoscopy should be avoided?

Conditions in which endoscopy is contraindicated include peritonitis, cardiovascular collapse, intestinal perforation, airway instability, gastrointestinal surgery recently, coagulopathy, and thrombocytopenia.

 

Dr. Srikanth K P

Consultant - Paediatric Gastroenterology and Hepatology

Manipal Hospitals Bangalore – Old Airport Road

 

 

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