Gastroenterologic endoscopy in children: past, present, and future

Perhaps it was the innate human fear of the dark, or the recognition that health was linked in some way to diet. Maybe it was the Hippocratic description of dyspepsia. Whatever the reason, the human desire to peer inside the body was a driving force in the development of endoscopy. The field of gastroenterology began with the Phillip Bozzini's crude, candle-powered lichtleiter in 1805 and blossomed with the introduction of flexible gastrointestinal endoscopy by Basil Hirschowitz in the late 1950s. Pediatric gastroenterology began early 1970s. Fueled by the application of gastrointestinal endoscopy to childhood digestive disease, pediatric gastroenterology has emerged as one of the most diverse medical-surgical practices in modern medicine. Pediatric endoscopists are alerted to prolapse gastropathy, a more accurate description of an old and possibly common cause of upper gastrointestinal bleeding in children. Pediatric endoscopic retrograde cholangiopancreatography continues to evolve, with increasing use in the diagnosis of infant cholestasis and endoscopic treatment of pancreatitis. These developments suggest a need for advanced training in endoscopy for pediatric gastroenterologists. Trends in gastrointestinal endoscopy are moving toward more therapeutic procedures and less diagnostic endoscopy. Therapeutic endoscopy, for example, may soon include antireflux operations. Computer-assisted virtual endoscopy and the wireless pill videoendoscope may replace diagnostic endoscopy eventually. The purpose of this review is to explore the origins of pediatric endoscopy, discuss current innovations, and look at the future of our discipline.