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[Digestive endoscopy in neonates. Personal experience]
F Fornaroli1, M Manfredi, P L Bacchini
1Istituto Policattedra di Pediatria, Servizio di Gastroenterologia ed Endoscopia digestiva via Gramsci 14, 43100 Parma.
Insights
Gastrointestinal (GI) endoscopy is a safe and effective diagnostic and therapeutic tool for neonates. This study highlights its high accuracy in diagnosing mucosal lesions in infants, proving superior to radiology.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Diagnostic Endoscopy
Context:
- Gastrointestinal (GI) endoscopy is crucial for diagnosing and treating conditions in newborns.
- Current limitations exist in exploring distal bowel segments, necessitating careful consideration for lower GI endoscopy.
- Neonatal endoscopy should be rapid to avoid the need for premedication.
Purpose:
- To evaluate the diagnostic accuracy and therapeutic utility of GI endoscopy in neonates.
- To analyze the outcomes of upper and lower GI endoscopies in two neonatal age groups (0-14 days and 15-28 days).
Summary:
- A retrospective study analyzed 127 GI endoscopies in neonates from 1983 to 2000.
- Upper GI endoscopy, indicated primarily for reflux and vomiting (86%), demonstrated high diagnostic sensitivity and specificity.
- Lower GI endoscopy, performed for intestinal bleeding, also proved valuable, with 7 esophageal dilatations performed during upper procedures.
Impact:
- GI endoscopy offers superior diagnostic accuracy for mucosal lesions compared to radiology in neonates.
- Endoscopy serves as both a vital diagnostic and therapeutic intervention for neonatal gastrointestinal diseases.
- Experienced endoscopists are essential for performing these procedures safely and effectively in the neonatal population.
Abstract:
Gastrointestinal (GI) endoscopy is actually considered an essential diagnostic and therapeutic technique both in pediatrician and in newborn infants. At the moment upper GI endoscopy in neonatal age allows to explore the esophagus, stomach and duodenum; instead lower GI endoscopy easily reaches sigmoid-colon junction. The exploration of other distal parts of bowel is more difficult and with more risks. Therefore it has to be make only if it is necessary. In the newborn this exam should be so fast not to require premedication. In our study, we considered every neonatal patient who underwent GI endoscopy at the "Digestive Endoscopy and Gastroenterology Service of Pediatric Clinic-University of Parma" (from September 1983 to June 2000). We considered two groups of patients: first group: early neonatal age (0-14 days) second group: late neonatal age (15-28 days). We made 127 endoscopies: 112 of these were upper GI. The most frequent symptoms that babies showed and indicated upper GI endoscopy were reflux and/or vomiting (86%). Upper operative GI endoscopies included also 7 esophageal dilatations. The lower GI endoscopies were 15 and in all the cases the indication was intestinal bleeding. We conclude that the GI endoscopy in the neonates shows a diagnostic sensibility and specificity really high and for sure better than the radiology for mucosal lesions. Also GI endoscopy can be not only a very precious diagnostic instrument but also therapeutic in neonatal disease. Considering the age of the little patients, it is very important that only endoscopists with large experience use this technique.