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Therapeutic gastrointestinal endoscopy
S K Yachha1, A Srivastava, B C Sharma
1Department of Gastroenterology (Pediatric GE), Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow.
Insights
Therapeutic gastrointestinal endoscopy in children is safe and effective for treating conditions like esophageal varices and strictures. Procedures such as injection sclerotherapy and dilation show high success rates with minimal complications in expert hands.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Endoscopy
- Therapeutic Procedures
Background:
- Therapeutic gastrointestinal (GI) endoscopy is crucial for managing pediatric GI conditions.
- Data on the safety and efficacy of these procedures in children, particularly in developing countries, is limited.
- Understanding outcomes is vital for optimizing pediatric GI care.
Purpose of the Study:
- To evaluate the safety, efficacy, and utility of various therapeutic GI endoscopic procedures in children.
- To analyze outcomes of upper and lower GI endoscopic interventions.
- To assess complication rates and management strategies.
Main Methods:
- Retrospective study of 1,030 therapeutic GI endoscopic sessions in 162 children (January 1992-July 1995).
- Procedures included injection sclerotherapy (EIS), endoscopic variceal ligation (EVL), dilations, and foreign body retrieval.
- Data collected on procedure types, indications, outcomes, and complications.
Main Results:
- Upper GI procedures: EIS for varices (75%) showed 100% bleeding control and 85% eradication, with 9% minor complications.
- EVL was effective without complications. Dilations and foreign body retrievals were also safe and effective.
- Lower GI procedures: Colonoscopic polypectomy was performed in 92% of cases; one perforation occurred.
Conclusions:
- Pediatric therapeutic GI endoscopy is highly effective and safe.
- Major complications are rare in experienced hands; minor complications are manageable conservatively.
- These procedures offer a valuable treatment modality for pediatric GI disorders.
Abstract:
The safety, efficacy and utility of various therapeutic gastrointestinal (GI) endoscopic procedures performed on children (January 1992 to July 1995) at a tertiary referral centre in India were studied. A total of 1,030 sessions (upper GI 972 and lower GI 58) of therapeutic GI endoscopy were performed in 162 children (mean age 7.4 +/- 4 years; upper GI 115, lower GI 47). Various upper GI endoscopic procedures done were injection sclerotherapy (EIS), endoscopic variceal ligation (EVL), bougie dilatation of oesophageal strictures, balloon dilatations of oesophageal stricture/pyloric obstruction and retrieval of foreign bodies in 75%, 6%, 9%, 4% and 12% of children respectively. Therapy for bleeding from oesophageal varices constituted the major group (75%). Repeated EIS (sessions total--876, mean 8, range 5-15) performed on 86 children resulted in control of bleeding in all and eradication of oesophageal varices in 85% of cases. Minor complications (oesophageal ulcers and oesophageal strictures) due to EIS were observed in 9% of children. EVL (10 sessions in 7 children) was effective in controlling bleeding and substantial decrease of varices in all without any complication. Oesophageal dilation either by bougie (61 sessions in 10 children) or balloon (6 sessions in 3 children) were performed for benign strictures. Balloon dilatation of pyloric obstruction was successfully done in 2 children. Foreign bodies (retained or sharp) were retrieved from upper GI tract in 14 children. No complications were observed with stricture dilatation/foreign body retrieval. Therapeutic lower GI endoscopies were performed in 47 children (colonoscopic polypectomy in 92%, anal dilatation and piles banding in 4% each). One child with juvenile polyposis coli developed sigmoid colon performation following colonoscopic polypectomy which required surgical correction. We conclude that upper and lower GI endoscopic therapeutic procedures in children are highly effective and safe. The risk of major complication is very small in experienced hands and occasional minor complications, can be managed conservatively.